Florida Cancer Specialists FCS Magazine Winter 2017-2018 by Florida Cancer Specialists

FCS THE MAGAZINE

FCSâ&#x20AC;&#x2122; Gynecologic Oncology Program A Month of Pink 2017 Clinical Summit FLCANCER.COM

WINTER 2017-2018

Thank You!

The Executive & Senior Management team wish you and your loved ones a wonderful holiday season! Thank you for your hard work and dedication throughout 2017.

FLCancer.com

Winter 2018

Contents

Erica Kranz, RN, with daughters Kaitlyn and Madison.

In This Issue

DEPARTMENTS 6 FCS News 9 HR Happenings 26 FCS Events

SPOTLIGHTS 10 Doctor Spotlight: Gynecologic Oncology Program 30 Nurse Spotlight: Erica Kranz, R.N. 32 Office Spotlight: North Fort Myers 34 Senior Management Team Spotlight:

Tara Ruska, CPA, MSAT

FEATURES 12 A Month of Pink 20 FLASCO Conference 22 Operations Meeting 24 2017 Clinical Summit 36 Hurricane Help

Winter 2018

Letter

FCS: CULTURE OF GROWTH

BY DR. WILLIAM HARWIN, FOUNDER & MANAGING PARTNER, AND BRAD PRECHTL, CEO

DR. HARWIN: Brad and I along with

members of our Executive Board and Management recently participated in the annual Florida Cancer Specialists Clinical Summit, held at the end of October in Orlando, FL. It is an event that I truly look forward to every year because it is an opportunity to connect with physicians and leaders throughout the practice. Again, this year, Dr. Neil Love’s “Research to Practice” program provided an excellent continuing educational platform for our physicians and other clinicians and our strategic partners from Sara Cannon Research Institute updated us on the amazing work going on in clinical research, led by Drs. Manish Patel and Judy Wang in our Sarasota Drug Development Unit (DDU), which is dedicated exclusively to Phase I Clinical Trials. During 2017, we welcomed nearly 20 new physicians to the practice, and we are delighted that 10 FCS physicians have now become partners. Several of our facilities underwent major renovations and in The Villages and North Fort Myers, we built new cancer centers to better serve the communities in Lake and Lee Counties. In addition to these new locations, we added offices in Stuart and Fleming Island, which added Martin and Clay Counties to our statewide practice.

BRAD PRECHTL: As Dr. Harwin pointed out, we have experienced unprecedented growth across our network. In addition, FCS is setting a national benchmark in community oncology. Our physicians have provided leadership at both COA (Community Oncology Alliance) and FLASCO (Florida Society of Clinical Oncology) and we are continuing to set the highest standards, as FCS continues its transition to a value-based care model. In early September, we faced one of the most powerful hurricanes ever to hit Florida. Hurricane Irma forced us to close every one of our clinics. However, our well-planned response, coupled with a remarkable team effort, led by COO Todd Schonherz and the Senior Management Team, allowed FCS to return to complete operations within 48 hours after the storm had passed. Despite the ongoing challenges in the healthcare arena, and our weather-related difficulties, FCS has continued to thrive. This is mainly due to your professional excellence and our mutual dedication to our patients. Thank you for your continued support and here’s to an even better 2018.

FCS The Magazine

FCS

THE MAGAZINE

Editor's

PHYSICIAN LEADERSHIP PRESIDENT

WILLIAM N. HARWIN, M.D. ASSISTANT MANAGING PARTNER, DIRECTOR, EXECUTIVE BOARD

STEPHEN V. ORMAN, M.D.

DIRECTOR OF PATIENT ADVOCACY, DIRECTOR, EXECUTIVE BOARD

MICHAEL DIAZ, M.D.

DIRECTOR OF QUALITY AND MEDICAL INFORMATICS

LUCIO GORDAN, M.D.

SCIENTIFIC DIRECTOR OF CLINICAL RESEARCH, DIRECTOR, DRUG DEVELOPMENT PROGRAM

LOWELL L. HART, M.D.

DIRECTOR OF RESEARCH OPERATIONS

JAMES A. REEVES, JR., M.D.

EXECUTIVE MANAGEMENT CHIEF EXECUTIVE OFFICER

BRAD PRECHTL

CHIEF OPERATING OFFICER

TODD SCHONHERZ GENERAL COUNSEL

TOM CLARK

CHIEF MARKETING & SALES OFFICER

SHELLY GLENN

CHIEF REVENUE CYCLE OFFICER

SARAH CEVALLOS

SENIOR MANAGEMENT RICH DYSON JEFF ESHAM MICHAEL ESSIK JEFFREY RUBIN TARA RUSKA INGA GONZALEZ RAY BAILEY CHRISTY BANACH LOIS BROWN MELISA CHANDLER MELODY CHANG DAVID CURRY CLAUDIA FRENCH KATIE GOODMAN LEVESTER JONES SUE KEARNEY MARK MOCH NICOLE PICAZIO ANNIE PIGUE LOIS POEL LYNN SAWYER LAURA SPERRY SIERRA TOMLINSON DENICE VEATCH SAMANTHA WATKINS DON CHAMPLAIN KATHERINE HOGAN ANNE RONCO

IN PARTNERSHIP WITH

PUBLISHED BY

Thank You for Your Continued Support of the FCS Foundation! The FCS Foundation fulfills a unique purpose for cancer patients who are struggling to pay their everyday living expenses. Imagine cancer patients who can’t make car payments leaving them without transportation to their physician’s office; or patients who can’t pay mortgage or rent and are facing eviction while they are fighting for their lives. The Foundation pays for non-medical expenses such as mortgage, rent, utilities and car payments, so that patients can concentrate on recovering from cancer.

What Separates the FCS Foundation from Other Charities? Florida Cancer Specialists pays the overhead, which means that 100% of all donations go directly to help cancer patients in need! The FCS Foundation provides help for the entire family, as well, by relieving some of the stress cancer patients and their family members face on a daily basis.

You Can Make a Difference. Volunteer. The Florida Cancer Specialists Foundation is seeking volunteers to provide non-medical support and comfort to patients undergoing treatment for cancer at Florida Cancer Specialists clinics. Duties include offering a pillow, warm blanket, snack or beverage to the patient, sharing a magazine and providing companionship. Applications are available at Foundation.FLCancer.com/Volunteer or send email inquiries to: VolunteerProgram@FLCancer.com

5204 Paylor Lane, Sarasota, FL 34240

For more info or to donate, call (941) 677.7181 or visit Foundation.FLCancer.com Winter 2018 5

FCS News

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Special Patient Gives and Receives

On Tuesday, September 12, 2017, a young man with Hodgkin’s lymphoma arrived at a Florida Cancer Specialists office seeking care. As an electrical worker, he had journeyed to Florida from Illinois to help communities damaged by Irma restore electrical power. He was scheduled to receive his final chemotherapy treatment back in Illinois in three days, but he didn’t believe he was going to make it back home in time. Complicating matters even more was the fact that he had an infected port. Ernesto Bustinza, MD, Medical Oncologist at FCS, said the patient was driving by the FCS clinic in Deland when he saw the practice’s sign and came in. Dr. Bustinza and the team were able to contact the patient’s oncologist in Illinois to acquire information necessary to treat him. Dr. Bustinza treated the infected port, referred the patient to get a new PICC line and scheduled him for the final chemotherapy treatment. “I think he actually put his life at risk to help others,” said Dr. Bustinza. “He was so nice and totally willing to help and assist, and he really didn’t think about himself. He was thinking more about the rest of the people. We wanted to be able to provide the same type of kindness and great service to him and I think we did.”

Dr. Deborah Glick Joins FCS in Naples West and Bonita Springs as First Time Hematologist

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Florida Cancer Specialists proudly welcomes Dr. Deborah Z. Glick, in our Naples West and Bonita Springs locations. Dr. Glick graduated Magna Cum Laude from the University of Pennsylvania and earned her medical degree from Tulane University School of Medicine in New Orleans, Louisiana. She has practiced medical hematology in Florida since 2003 and served as an assistant professor in Debra Glick, M.D. the Department of Medicine, Division of Hematology-Oncology, at the University of Miami Sylvester Comprehensive Care Center.

Ribbon Cutting | Stuart

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On September 28, 2017, local dignitaries joined the physicians and staff of FCS for the ribbon cutting ceremony to celebrate the newly renovated Stuart location.

Dr. Michael Scott Joins FCS at Tampa Cancer Center

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On November 1, 2017, Dr. Michael T. Scott joined FCS at the Tampa Cancer Center as a Radiation Oncologist. Dr. Scott received his B.S.E. degree in Biomedical Engineering at Duke University located in Durham, NC, and attended medical and graduate school at the University of Florida Dr. Mohammad K. Kamal Joins New Ocala Office (UF), located in Gainesville, FL. In 2011, he graduated from UF with his Medical degree and Masters in On October 1, 2017, Dr. Business Administration. After graduating, Mohammad K. Kamal joined FCS he relocated to Miami, Florida, where he at the new Ocala location. completed his Residency at the University of Dr. Kamal attended medical school Miami (UM) Sylvester Comprehensive Cancer in Mosul, Iraq, at the University of Center/Jackson Memorial Hospital and was Mosul. After graduating, he relocated awarded Chief Resident. Dr. Scott is boardto Johnson City, Tennessee, where he certified by the American Board of Radiology completed his Residency and Fellowship (ABR) and has been published in several peer in Oncology/Hematology at East reviewed journals. Currently, he is involved Tennessee State University. Dr. Kamal in American Society of Clinical Oncology has had a successful private practice in Mohammad K. Kamal, M.D. Michael T. Scott, M.D. (ASCO), Florida Society of Clinical Oncology Marion County since 1985. He serves (FLASCO), American College of Radiation (ACR), Florida Radiological as a Board Member of Ocala Regional Society (FRS) and the American Society of Therapeutic Radiation Medical Center and West Marion Community Hospital. He is Oncology (ASTRO). Fluent in Spanish, Dr. Scott enjoys playing tennis, married with three children and enjoys golf, fishing, soccer and golfing and traveling in his spare time. skiing.

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FCS The Magazine

FCS

News Blanket Warmer Donation | St. Anthony’s Hospital

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On October 5, 2017, Bobbi and Dave Norris of the Make a Difference Foundation passed along the gift of warmth to patients by donating a new blanket warmer to the St. Anthony’s location.

Lakewood Ranch Community Fund Reception

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On October 6, 2017, the FCS Foundation was awarded a grant for $4,500 from the Lakewood Ranch Community Fund for non-medical living expenses for cancer patients in need. Pictured left to right | LWR Community Fund Board Member Shari Phillips and FCS Foundation Executive Director Lynn Rasys.

WFLA Morning News Anchor | Patient Story for Experience at the FCS Mease Location

Pictured in photo left to right | Dr. Michael Diaz, Bobbi Norris, Dave Norris, David Norris and CMSO Shelly H Glenn.

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Dr. Michael Diaz | Appointed to Medicaid Committee

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On October 20, 2017, Governor Rick Scott appointed Dr. Michael Diaz to the Medicaid Pharmaceutical and Therapeutics Committee. Dr. Diaz succeeds Dr. Mark Hudak, and was appointed for a term beginning October 17, 2017 – June 30, 2019. Dr. Diaz commented, “Previously, there was no oncology representation on the Medicaid Pharmaceutical and Therapeutics Committee. I am very grateful to have this opportunity to serve as a committee member, and hope to provide insight from the field of oncology and hematology.”

Pictured left to right | Stephanie Bail, FCS Patient of Dr. Marte, Sheree Clark, WFLA Morning News Anchor Gayle Guyardo, Cory Lepak Michael Diaz, M.D.

Dr. Augusto Villegas Publishes New Clinical Research

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Dr. Augusto Villegas, who practices at the Florida Cancer Specialists (FCS) location in Fleming Island, was second author of an important new study demonstrating the effectiveness of durvalumab after concurrent chemoradiotherapy (cCRT) in extending progression-free survival (PFS) in patients with Stage III Non-SmallCell Lung Cancer (NSCLC). Published in the September 8, 2017 issue of the New Augusto Villegas, M.D. England Journal of Medicine (NEJM), the randomized, double-blind, international study showed a PFS benefit with durvalumab was observed across all pre-specified groups, as compared to placebo.

Pictured | Dr. Marte’s patient, Sheree Clark

Dr. Syed Zafar Named Department Chair at Gulf Coast Medical Center

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Dr. Syed Zafar was elected Chair of the Department of Medicine at Gulf Coast Medical Center.

Dr. Zafar practices at the Colonial, North Fort Myers and Gladiolus locations of FCS in Southwest Florida. Syed Zafar, M.D.

Winter 2018

FCS

News Ask the Experts Dinner with Docs | Florida Hospital North Pinellas

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Pictured left to right | Dr. Paul Arnold, Urology Specialists of West Florida; Dr. David Wenk, New Port Richey; and Dr. Douglas Reintgen.

Pictured left to right | Physician Liaison JoLynn Wright, Dr. David Wenk and Physician Liaison Sandy Brooks

AutoNation Donates Gift Bags to FCS Patients in Brooksville

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Pictured left to right | Diana Hulen, Alison Murty, Dr. Malhotra, and Christine Thompson

FCS The Magazine

New Study: Cancer Care is Far More Expensive Delivered in Hospital Outpatient Setting

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A report released September 25, 2017, by Xcenda, an AmerisourceBergen Company, conducted with support from Florida Cancer Specialists, found that the total cost of care for cancer patients receiving chemotherapy delivered in the hospital outpatient setting is nearly 60%, or $90,144 per year, more expensive than the same treatment delivered in independent, community oncology practices. Additionally, the report says cancer patients treated in the hospital setting are more likely to visit the emergency department (ED) following treatment. The study, titled “The Value of Community Oncology: Site of Care Cost Analysis,” was led by Lucio Gordan, MD, Medical Director in the Division of Quality & Informatics at Florida Cancer Specialists & Research Institute, and by Xcenda, a global health economics consultancy. It was released by the Community Oncology Alliance (COA), a non-profit organization dedicated to preserving and protecting access to community cancer care, where most Americans with cancer are treated. Across all cancers, the analysis demonstrated that total cost of care for a patient receiving chemotherapy within the hospital outpatient setting was 59.9% higher than for those patients treated in the community practices ($20,060 vs. $12,548 monthly). The biggest drivers for the cost differential were the cost of chemotherapy (71% higher, or $3,510 more expensive per month in the hospital setting) and the cost of physician visits (333% higher, or $2,551 more expensive in the hospital setting). The analysis also found that rates of emergency department visits by cancer patients following chemotherapy were higher in the hospital outpatient setting. The report looked at specific data for total cost differentials by type of cancer for breast, lung, and colorectal cancer patients. The data was consistent in showing that costs for these cancers were significantly higher for cancer care delivered in the hospital outpatient setting than in the community practices. The results held regardless whether the chemotherapy drugs used were branded, generic or a combination of brand and generic. “As a physician, I am constantly concerned about the financial toxicity of cancer care. It is disappointing again to see data that hospital-based cancer care is considerably more expensive than the community practices. While, at the same time, more patients are being forced into hospitals,” said Dr. Gordan. “Providers, payers, policymakers and patients need to take a long hard look at the impact that site of care has on cancer patients, not just in terms of the cost, but also outcomes, quality of care, and satisfaction. It is clear that the community oncology setting should be the preferred, first choice treatment setting for cancer patients.” The findings of this study were consistent with at least 10 previous studies between 2011 and 2016 that found the average cost of cancer care was 38% higher for patients treated in hospital outpatient settings compared with those treated in the community practices.

ATTENTION FCS EMPLOYEES

NEW BENEFIT FOR 2018

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Beginning January 1, 2018, FCS is pleased to provide Teladoc services to employees enrolled in our medical plan. FCS subsidizes a portion of every Teladoc visit and expects the 365/24/7 convenience of Teladoc to be a welcome alternative when medical care is needed. A welcome letter is being sent to employees homes with instructions on setting up their Teladoc account. MEET OUR DOCTORS

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© 2017 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.

04052016 10E-137B

Winter 2018

DOCTOR SPOTLIGHT

FCS The Magazine

The Gynecologic Oncology Program at FCS

Fighting on the Front Lines in a Specialized Field

BY ERIN HOOVER

he doctors practicing gynecologic oncology across the United States make up a small, specialized community, and FCS is fortunate to have two experts in the field, serving patients in the Palm Beach County area. Dr. Howard M. Goodman joined FCS when his practice, Palm Beach Cancer Institute, merged with FCS in 2013. In 2015, he invited Dr. Antonella Leary, then working at another oncology practice in Florida, to join him. Drs. Goodman and Leary treat malignancies of the female reproductive system: ovarian, cervical, uterine, vaginal, vulvar and endometrial cancers. Gynecologic oncology can be considered a narrow specialty in that it solely involves women, but treating female reproductive malignancies involves a broad set of skills, said Dr. Goodman. “To a great degree, what draws many young physicians into gynecologic oncology, as opposed to other specialties, is that we do some primary care, we perform complex surgery, we do chemotherapy and we are involved in radiation therapy. We cover all of those bases within our field of expertise.” Dr. Leary works in the Palm Beach Gardens location and at Wellington. Dr. Goodman works at Good Samaritan Medical Center and Atlantis. The two put their heads together often to help patients. “Dr. Goodman and I see patients at different FCS offices to better serve the need in the county. Although we work at geographically separate offices, we work as a team often collaborating on cases,” said Dr. Leary. “I’ll call Dr. Goodman or he’ll call me to discuss a case, or we’ll help each other out in the operating room.” The two doctors also run a tumor board, in which patient cases are presented without identifying information. At these sessions, they are joined by the pathologist, the radiologist, the radiation oncologist, and the medical oncologist. That way, Dr. Leary says, “Nobody gets treated in a vacuum. We come up with a joint plan with physicians of multiple specialties having input.” “The parent specialty, of course, for gynecologic oncology is obstetrics and gynecology,” said Dr. Goodman. “You have to complete a four-year residency program in OB-GYN, hence all gynecologic oncologists are board-certified in gynecology and obstetrics even though virtually none of us practice obstetrics anymore. As a result of the advanced surgical training required to treat many female cancers, across the country gynecologic oncologists tend to be the ‘go to’ GYN surgeon for complex benign gynecologic problems such as large fibroids, severe pelvic infections, large pelvic masses and severe endometriosis,” he continued. Though Dr. Goodman enjoyed practicing obstetrics, he found during his residency that he preferred the challenges of oncologic surgery. “I think the most rewarding part of my

job is walking out of the operating room having safely and successfully done a very difficult surgery and being able to tell the family that all went well. In some instances, that involves getting called in by our OB-GYN colleagues who have encountered a difficult surgical problem either in the operating room or even in the obstetrical unit.” “I knew obstetrics wasn’t for me,” said Dr. Leary. “I like operating, and I like complex cases. I wanted to help those patients.” She continued, “There is nothing like the courage of a cancer patient.” As part of her training, Dr. Leary volunteered to teach and provide support on Native American reservations, with a general surgeon in Mexico, and with another gynecologic oncologist practicing in the Dominican Republic. “The people I had the opportunity to work with may have learned a little from me — on the other hand, I had the privilege of learning from them what it is to be resilient, and how to be brave and fight.” Outside the demands of work, each doctor focuses his or her energy on family. “My kids range from age 5 to 14,” said Dr. Leary. “When I go home, I take off my doctor hat as much as I can and play mommy. But my kids also come on rounds with me. They sometimes ask questions, and my dinner conversation is pretty interesting.” Dr. Goodman has two sons, one who will soon complete a Ph.D. in political science, and another who is a classical musician. Drs. Leary and Goodman are both excited about advances in the surgical and medical treatments of reproductive cancers, made mostly within the last decade. “Cancer is not the death sentence that it used to be. The advent of new treatments and adjuncts to chemo, such as biologic treatments, PARP inhibitors, and VEGF inhibitors, have revolutionized medicine in the treatment of some cancers,” said Dr. Leary. “Robotic surgery has also revolutionized cancer treatment. No longer do we have to make big incisions that keep people out of work.” Dr. Goodman echoed Dr. Leary’s appreciation for new surgical advancements, adding, “We’re all excited about the specialty or science of genomics, with so-called ‘personalized medicine’ or ‘targeted therapy,’ where we’re able to test a tumor, find gene abnormalities within that tumor and prescribe chemotherapy or drugs that can target those abnormalities.” Advances in the field are moving quickly, yet the specialty is relatively young. The Society of Gynecologic Oncology celebrates its 50th anniversary next year, said Dr. Goodman. “That’s a very exciting milestone for us,” he said. In Palm Beach, FCS’s gynecologic oncologists find themselves fighting on the front lines of reproductive health. “I’d be happy to be put out of business,” Dr. Leary said. “But since we haven’t found a cure, my goal is to keep the cancer away as long as possible, if not forever.”

Winter 2018

A Month of Pink

FCS Participates in Hundreds of Breast Cancer Awareness Month Activities BY KIM HARRIS THACKER

or one month a year, the world goes pink, as millions of determined people band together against a formidable foe: breast cancer. The Florida Cancer Specialists team is determined to put an end to breast cancer, which, according to the Centers for Disease Control and Prevention, is the secondmost common form of cancer among American women. During the month of October, representatives from FCS were present at numerous fundraisers around the state including 5K runs and auctions to benefit breast cancer patients. It’s as if pink is their favorite color. “Supporting community initiatives that are dedicated to raising funds to benefit cancer patients and support research is an important part of our mission,” says Dr. Vipul Patel, who participated in a Making Strides Against Breast Cancer event in Ocala. “And we undertake activities to support our own Foundation.” “Throughout the year, our staff and physicians are very involved in cancer-related initiatives,” says Chief Marketing and Sales Officer, Shelly Glenn. “It’s about the patients we serve. If we’re not supporting charities and non-profits that step up for breast cancer awareness during the month of October, we’re not doing right by our patients and staff.” The Revenue Cycle team at FCS’s corporate office spearheaded an innovative way to raise awareness and funds for the FCS Foundation. Corporate-based employees recently participated in “Pink Day” by wearing pink and making a donation to the Foundation, which assists cancer patients in need with non-medical living expenses.

FCS The Magazine

Making Strides Against Breast Cancer, Pink Out and Bowling 4 Boobs were among other special events in which FCS was involved across Florida this past October. The organization also invested in education initiatives to inform, educate and elevate the knowledge base of the Florida public and the medical professionals who serve these individuals. Certainly, October is known for breast cancer awareness. Likewise, as other months focus on other types of cancer, Glenn says FCS is there to support awareness of those diseases, too. “It’s a continual process and a continual commitment,” she says. “We’re increasing education and awareness throughout the year for every type of cancer we treat. In doing so, we strive to increase the positive outcomes and level of survival.” “It’s great that we’re doing the walks and that we’re educating and participating, but it’s really important that we also move the dial — move everything forward — with Clinical Trials.” “We work in partnership with Sarah Cannon Research Institute in administering Phase I, II and III Clinical Trials. We have access to approximately 120 pre-FDA approved trials at many of our facilities that are located strategically throughout the state. In 2016, of all the cancer drugs that were approved by the FDA, 84 percent of them came from trials in which FCS participated.” Now that’s moving the dial, indeed.

Pink Out – Breast Cancer Awareness for Community at Florida Hospital Waterman. Pictured left to right: Annie Pigue, Associate Regional Director; Donna Swearingen, Office Manager; and Danielle Spears, Senior Physician Liaison Manager.

The FCS New Port Richey team sponsored Bowling 4 Boobs at Lane Glo Bowl. Pictured left to right on the first row: Laura Henderson Mulroy, Amanda Ernest, Patty Rogers, Tammy Goodnight, Dr. Gail Wright and Richard Wright. Second row: Karen Czock, JoLynn Wright, Roger Porzio and Rennae Revell. Third row: Ed Czock, Sam McIntyre, Anja Spindle, Freddie Ortiz, Patty Ortiz and Shannon Douglass.

Making Strides Against Breast Cancer in Vero Beach. Pictured left to right: Luzmarina Painter, Chloe Sujdak, Dr. Hugo Davila, Samuel Davila, Adiris Moraguez, Diana Gonzales, Adriana Gonzales, Dr. Raul Storey, Cheryl Conlee, Chrystal Lewis, Jazmyne Pledger, Katrina Thompson and Dr. Jennifer Byer.

The FCS Foundation sponsored the Tampa Bay Buccaneers Treasure Chest 5K/10K for Breast Cancer Awareness Month.

Making Strides Against Breast Cancer in Pasco/ Hernando County. Pictured left to right: Shannon Douglas, Liz Rutter, Joann Dresch, Kim Fox, Sabrina Leon, Patty Ortiz, Freddy Ortiz, Jackie Reilly, Vickie Fletcher, Margaret Galon, Melissa Monahan, Sandra Reilly and JoLynn Wright.

In honor of Breast Cancer Awareness Month, FCS HR Recruiter Maureen Holland created a pink dragon out of a recycled ceiling-fan blade. She enjoys creating different repurposed items with her granddaughters.

Making Strides Against Breast Cancer in Ocala. Pictured left to right on the first row: Jordan Lassitter, Kristeen Foster, Dr. Shilpa Oberoi, Dennis Hipsley, Brett Hipsley & Shyam Patel (Dr. Patel’s son). Second row: Mailalen Patel (Dr. Patel’s daughter) and Dr. Vipul Patel.

Winter 2018

FCS

Pink Day 2017

Events 2.

1a.

3. 1B.

1C.

1D.

4. 5. 1E.

1. FCS CORPORATE AND FC TEAM Pink Day 2017 was another amazing success! Just between our two locations and the FCs for sending in their pictures, we raised $23,500 for the FCS Foundation!

2. SARASOTA DOWNTOWN The Sarasota Downtown lab raised $315 for the FCS Foundation!

And a special thank you to the Pink Day Committee for putting together all of the events. Your hard work and dedication to the event made it a true success!

Shea Clapp, Gina Mack, Angela Bacon, Willette Claridy, Shakeshia Parrimon, Joyce Sallye, Teyonna Wilcox, Stacy Weir, Emily Barnwell, Donna Malizia, Jackie Perrine, Robin Spalvins, Amy Testa Latasha Saffore.

1a. Standing: Wendy Shraiar, Holly Ortiz, Kaylyn Primus, Gail Reynolds, Jo Wilson, Demetria Matthews.

3. DAYTONA CANCER CENTER

Seated: Ginny Cook, Daniela Moreno, Raquel Gerl 1b. Debbie Kostinchuk, Marisol Espinoza, Santa Maria Jaimes. Adrianne Adams, and Krista McCowen. 1c. Yesenia Perez and Ruth Merlino. 1d. Wendy Shraiar and Jo Wilson. 1e. Liz Hoadley, Rosemary Taylor, Ophelia Canady, Nicole Telfort, Barry Belkin, Laura Garcia, Roxanne Bucknavage, and Charolette Nottage.

FCS The Magazine

Pictured left to right | - Sabrina Maldonado and Maria Candell.

4. FCS FOUNDATION VOLUNTEER DAVE BRYANT DRESSED FOR THE OCCASION!

5. DAYTONA CANCER CENTER RAISED $1,205 FOR THE FCS FOUNDATION BY HAVING A BASKET RAFFLE AND SELLING T-SHIRTS. Pictured left to right | Kim Heller FC, Patient â&#x20AC;&#x201C; basket winner, and Gina Helsel FC.

World-Class Medicine. Hometown Care.

S AV E

THE

DAT E

10.26-28

2018

2018 FCS Clinical Summit Ritz-Carlton Grande Lakes 4012 Central Florida Parkway Orlando, FL 32837

FLCancer.com Winter 2018

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EXTEND EXTENDTHE THE POSSIBILITIES. POSSIBILITIES. EXTEND EXTENDTHE THE

The approval The approval of theofNINLARO® the NINLARO® (ixazomib) (ixazomib) regimen regimen (NINLARO+lenalidomide+dexamethasone) (NINLARO+lenalidomide+dexamethasone) was based was based on a on statistically a statistically signifi signifi cant cant ~6 month ~6 month improvement improvement in median in median PFS vs PFS the vsplacebo the placebo regimen regimen (placebo+lenalidomide+dexamethasone).* (placebo+lenalidomide+dexamethasone).* • Median • Median PFS: PFS: 20.6 20.6 vs 14.7 vs months 14.7 months (95%(95% CI, 17.0-NE CI, 17.0-NE and 95% and 95% CI, 12.9-17.6, CI, 12.9-17.6, respectively); respectively); HR=0.74 HR=0.74 (95%(95% CI, 0.587-0.939); CI, 0.587-0.939); P=0.012 P=0.012

THE THE FIRST FIRST ANDAND ONLYONLY ORAL ORAL PROTEASOME PROTEASOME INHIBITOR INHIBITOR NCCN NCCN Clinical Clinical Practice Practice Guidelines Guidelines in Oncology in Oncology (NCCN (NCCN Guidelines®) Guidelines®) recommend recommend ixazomib ixazomib in combination in combination with with lenalidomide lenalidomide 1 1 and dexamethasone and dexamethasone as a category as a category 1 treatment 1 treatment option option for previously for previously treated treated multiple multiple myeloma. myeloma. NINLARO NINLARO is indicated is indicated in combination in combination with with lenalidomide lenalidomide and and dexamethasone dexamethasone for the fortreatment the treatment of patients of patients with with multiple multiple myeloma myeloma who who havehave received received at least at least one prior one prior therapy. therapy. IMPORTANT IMPORTANT SAFETY SAFETY INFORMATION INFORMATION WARNINGS WARNINGS ANDAND PRECAUTIONS PRECAUTIONS • Thrombocytopenia • Thrombocytopenia has been has been reported reported with with NINLARO. NINLARO. During During treatment, treatment, monitor monitor platelet platelet counts counts at least at least monthly, monthly, and consider and consider moremore frequent frequent monitoring monitoring during during the fithe rst three first three cycles. cycles. Manage Manage thrombocytopenia thrombocytopenia with with dosedose modifi modifi cations cations and platelet and platelet transfusions transfusions as per asstandard per standard medical medical guidelines. guidelines. Adjust Adjust dosing dosing as needed. as needed. Platelet Platelet nadirs nadirs occurred occurred between between DaysDays 14-2114-21 of each of each 28-day 28-day cyclecycle and typically and typically recovered recovered to to baseline baseline by the bystart the start of theofnext the next cycle.cycle. • Gastrointestinal • Gastrointestinal Toxicities, Toxicities, including including diarrhea, diarrhea, constipation, constipation, nausea nausea and vomiting, and vomiting, werewere reported reported with with NINLARO NINLARO and may and may occasionally occasionally require require the use theof use antidiarrheal of antidiarrheal and antiemetic and antiemetic medications, medications, and supportive and supportive care.care. Diarrhea Diarrhea resulted resulted in thein the discontinuation discontinuation of one ofor one more or more of theofthree the three drugsdrugs in 1%in of1% of patients patients in theinNINLARO the NINLARO regimen regimen and <and 1% < of1% patients of patients in thein the placebo placebo regimen. regimen. Adjust Adjust dosing dosing for severe for severe symptoms. symptoms. • Peripheral • Peripheral Neuropathy Neuropathy (predominantly (predominantly sensory) sensory) was was reported reported with with NINLARO. NINLARO. The most The most commonly commonly reported reported reaction reaction was peripheral was peripheral sensory sensory neuropathy neuropathy (19%(19% and 14% andin 14% in

the NINLARO the NINLARO and placebo and placebo regimens, regimens, respectively). respectively). Peripheral Peripheral motor motor neuropathy neuropathy was not wascommonly not commonly reported reported in either in either regimen regimen (< 1%). (< Peripheral 1%). Peripheral neuropathy neuropathy resulted resulted in in discontinuation discontinuation of one ofor one more or more of theofthree the three drugsdrugs in 1%in of1% of patients patients in both in both regimens. regimens. Monitor Monitor patients patients for symptoms for symptoms of of peripheral peripheral neuropathy neuropathy and adjust and adjust dosing dosing as needed. as needed. • Peripheral • Peripheral Edema Edema was reported was reported with with NINLARO. NINLARO. Monitor Monitor for for fluid flretention. uid retention. Investigate Investigate for underlying for underlying causes causes whenwhen appropriate appropriate and provide and provide supportive supportive care care as necessary. as necessary. Adjust Adjust dosing dosing of dexamethasone of dexamethasone per its per prescribing its prescribing information information or or NINLARO NINLARO for Grade for Grade 3 or 43 symptoms. or 4 symptoms. • Cutaneous • Cutaneous Reactions: Reactions: Rash,Rash, mostmost commonly commonly maculo-papular maculo-papular and macular and macular rash,rash, was reported was reported with with NINLARO. NINLARO. RashRash resulted resulted in discontinuation in discontinuation of one ofor one more or more of theofthree the three drugsdrugs in < 1% in < of1% of patients patients in both in both regimens. regimens. Manage Manage rash rash with with supportive supportive care care or with or with dosedose modifi modifi cation. cation. • Hepatotoxicity • Hepatotoxicity has been has been reported reported with with NINLARO. NINLARO. Drug-induced Drug-induced liver injury, liver injury, hepatocellular hepatocellular injury, injury, hepatic hepatic steatosis, steatosis, hepatitis hepatitis cholestatic cholestatic and hepatotoxicity and hepatotoxicity havehave eacheach beenbeen reported reported in < 1% in < of1% patients of patients treated treated with with NINLARO. NINLARO. Events Events of liver of impairment liver impairment havehave beenbeen reported reported (6% in (6% thein the NINLARO NINLARO regimen regimen and 5% andin5% theinplacebo the placebo regimen). regimen). Monitor Monitor hepatic hepatic enzymes enzymes regularly regularly during during treatment treatment and adjust and adjust dosing dosing as needed. as needed.

Under Under contract contract with with your your GPO. GPO.

Get Get more more information information at www.NINLAROhcp.com. at www.NINLAROhcp.com.

• Embryo-fetal • Embryo-fetal Toxicity: Toxicity: NINLARO NINLARO can cause can cause fetal fetal harm.harm. • Lactation: • Lactation: Advise Advise nursing nursing women women not to not breastfeed to breastfeed during during treatment treatment with with NINLARO NINLARO and for and90 fordays 90 days afterafter the last thedose. last dose. Women Women should should be advised be advised of theofpotential the potential risk to risk a fetus, to a fetus, to to avoidavoid becoming becoming pregnant, pregnant, and to and use tocontraception use contraception during during DRUG INTERACTIONS: INTERACTIONS: AvoidAvoid concomitant concomitant administration administration treatment treatment and for andanfor additional an additional 90 days 90 days afterafter the fithe nal fi dose nal dose DRUG of NINLARO with with strong strong CYP3A CYP3A inducers. inducers. of NINLARO. of NINLARO. Women Women usingusing hormonal hormonal contraceptives contraceptives should should of NINLARO also use alsoause barrier a barrier method method of contraception. of contraception. *TOURMALINE-MM1: *TOURMALINE-MM1: a global, a global, phase phase 3, randomized 3, randomized (1:1), (1:1), double-blind, double-blind, placebo-controlled placebo-controlled studystudy that evaluated that evaluated the safety the safety ADVERSE ADVERSE REACTIONS REACTIONS andcacy efficacy of NINLARO of NINLARO (an oral (an proteasome oral proteasome inhibitor) inhibitor) vs vs The most The most common common adverse adverse reactions reactions (≥ 20%) (≥ 20%) in theinNINLARO the NINLARO and effi placebo, both both in combination in combination with with lenalidomide lenalidomide and and regimen regimen and greater and greater than than the placebo the placebo regimen, regimen, respectively, respectively, placebo, dexamethasone, dexamethasone, until until disease disease progression progression or unacceptable or unacceptable werewere diarrhea diarrhea (42%,(42%, 36%),36%), constipation constipation (34%,(34%, 25%),25%), toxicity in 722 inpatients 722 patients with with relapsed relapsed and/or and/or refractory refractory multiple multiple thrombocytopenia thrombocytopenia (78%,(78%, 54%;54%; pooled pooled fromfrom adverse adverse events events and and toxicity 2 2 myeloma myeloma who who received received 1-3 prior 1-3 prior therapies. therapies. laboratory laboratory data),data), peripheral peripheral neuropathy neuropathy (28%,(28%, 21%),21%), nausea nausea (26%,(26%, 21%),21%), peripheral peripheral edema edema (25%,(25%, 18%),18%), vomiting vomiting (22%,(22%, 11%), and 11%),back and back The NCCN The NCCN Guidelines Guidelines are a work are a in work progress in progress that may thatbe may refibe ned refi asned often as often as as new signifi new signifi cant data cantbecomes data becomes available. available. The NCCN The NCCN Guidelines Guidelines are a statement are a statement pain (21%, pain (21%, 16%).16%). Serious Serious adverse adverse reactions reactions reported reported in ≥ 2% in ≥of2% of of consensus of consensus of its authors of its authors regarding regarding their views their views of currently of currently accepted accepted patients patients included included thrombocytopenia thrombocytopenia (2%) (2%) and diarrhea and diarrhea (2%).(2%). approaches approaches to treatment. to treatment. Any clinician Any clinician seeking seeking to apply to apply or consult or consult any NCCN any NCCN SPECIAL SPECIAL POPULATIONS POPULATIONS • Hepatic • Hepatic Impairment: Impairment: Reduce Reduce the NINLARO the NINLARO starting starting dosedose to 3 mg to 3inmg patients in patients with with moderate moderate or severe or severe hepatic hepatic impairment. impairment. • Renal • Renal Impairment: Impairment: Reduce Reduce the NINLARO the NINLARO starting starting dosedose to 3 mg to 3inmg patients in patients with with severe severe renalrenal impairment impairment or or end-stage end-stage renalrenal disease disease requiring requiring dialysis. dialysis. NINLARO NINLARO is is not dialyzable. not dialyzable.

Guidelines Guidelines is expected is expected to usetoindependent use independent medical medical judgment judgment in the in context the context of of individual individual clinicalclinical circumstances circumstances to determine to determine any patient’s any patient’s care or care treatment. or treatment. The National The National Comprehensive Comprehensive Cancer Cancer Network Network makesmakes no warranties no warranties of anyof any kind whatsoever kind whatsoever regarding regarding their content, their content, use oruse application or application and disclaims and disclaims any responsibility any responsibility for their forapplication their application or useorinuse anyinway. any way. NE=not NE=not evaluable; evaluable; PFS=progression-free PFS=progression-free survival. survival.

Please Please see adjacent see adjacent BriefBrief Summary. Summary.

USO/IXA/16/0100(3)d USO/IXA/16/0100(3)d

REFERENCES: 1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Multiple Myeloma T:7” V.3.2017. © National Comprehensive Cancer Network, Inc. 2016. All rights reserved. Accessed March 28, 2017. To view the most recent and complete version of the guideline, go online to NCCN.org. 2. Moreau P, Masszi T, Grzasko N, et al; for TOURMALINE-MM1 Study Group. Oral ixazomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2016;374(17):1621-1634.

BRIEF SUMMARY OF PRESCRIBING INFORMATION NINLARO (ixazomib) capsules, for oral use 1 INDICATION NINLARO (ixazomib) is indicated in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least one prior therapy.

IXAZ17CDNY1359_Brief_Summary_Sept_2017_Update_r3.indd 1

6 ADVERSE REACTIONS The following adverse reactions are described in detail in other sections of the prescribing information: • Thrombocytopenia [see Warnings and Precautions (5.1)] • Gastrointestinal Toxicities [see Warnings and Precautions (5.2)] • Peripheral Neuropathy [see Warnings and Precautions (5.3)] • Peripheral Edema [see Warnings and Precautions (5.4)] • Cutaneous Reactions [see Warnings and Precautions (5.5)] • Hepatotoxicity [see Warnings and Precautions (5.6)] 6.1 CLINICAL TRIALS EXPERIENCE Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety population from the randomized, double-blind, placebo-controlled clinical study included 720 patients with relapsed and/or refractory multiple myeloma, who received NINLARO in combination with lenalidomide and dexamethasone (NINLARO regimen; N=360) or placebo in combination with lenalidomide and dexamethasone (placebo regimen; N=360). The most frequently reported adverse reactions (≥ 20%) in the NINLARO regimen and greater than the placebo regimen were diarrhea, constipation, thrombocytopenia, peripheral neuropathy, nausea, peripheral edema, vomiting, and back pain. Serious adverse reactions reported in ≥ 2% of patients included thrombocytopenia (2%) and diarrhea (2%). For each adverse reaction, one or more of the three drugs was discontinued in ≤ 1% of patients in the NINLARO regimen. Table 4: Non-Hematologic Adverse Reactions Occurring in ≥ 5% of Patients with a ≥ 5% Difference Between the NINLARO Regimen and the Placebo Regimen (All Grades, Grade 3 and Grade 4) NINLARO + Lenalidomide and Dexamethasone N=360

Placebo + Lenalidomide and Dexamethasone N=360

N (%)

System Organ Class / Preferred Term All

Grade 3

Grade 4

All

Grade 3

Grade 4

Infections and infestations Upper respiratory tract infection

69 (19)

1 (< 1)

52 (14)

2 (< 1)

Nervous system disorders Peripheral neuropathies*

100 (28)

7 (2)

77 (21)

7 (2)

Gastrointestinal disorders Diarrhea Constipation Nausea Vomiting

151 (42) 122 (34) 92 (26) 79 (22)

22 (6) 1 (< 1) 6 (2) 4 (1)

0 0 0 0

130 (36) 90 (25) 74 (21) 38 (11)

8 (2) 1 (< 1)

0 2 (< 1)

0 0 0 0

Skin and subcutaneous tissue disorders Rash*

68 (19)

9 (3)

38 (11)

5 (1)

Musculoskeletal and connective tissue disorders Back pain

74 (21)

2 (< 1)

57 (16)

9 (3)

General disorders and administration site conditions Edema peripheral

91 (25)

8 (2)

66 (18)

4 (1)

Note: Adverse reactions included as preferred terms are based on MedDRA version 16.0. *Represents a pooling of preferred terms

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5 WARNINGS AND PRECAUTIONS 5.1 Thrombocytopenia: Thrombocytopenia has been reported with NINLARO with platelet nadirs typically occurring between Days 14-21 of each 28-day cycle and recovery to baseline by the start of the next cycle. Three percent of patients in the NINLARO regimen and 1% of patients in the placebo regimen had a platelet count ≤ 10,000/mm3 during treatment. Less than 1% of patients in both regimens had a platelet count ≤ 5000/mm3 during treatment. Discontinuations due to thrombocytopenia were similar in both regimens (< 1% of patients in the NINLARO regimen and 2% of patients in the placebo regimen discontinued one or more of the three drugs).The rate of platelet transfusions was 6% in the NINLARO regimen and 5% in the placebo regimen. Monitor platelet counts at least monthly during treatment with NINLARO. Consider more frequent monitoring during the first three cycles. Manage thrombocytopenia with dose modifications and platelet transfusions as per standard medical guidelines. 5.2 Gastrointestinal Toxicities: Diarrhea, constipation, nausea, and vomiting, have been reported with NINLARO, occasionally requiring use of antidiarrheal and antiemetic medications, and supportive care. Diarrhea was reported in 42% of patients in the NINLARO regimen and 36% in the placebo regimen, constipation in 34% and 25%, respectively, nausea in 26% and 21%, respectively, and vomiting in 22% and 11%, respectively. Diarrhea resulted in discontinuation of one or more of the three drugs in 1% of patients in the NINLARO regimen and < 1% of patients in the placebo regimen. Adjust dosing for Grade 3 or 4 symptoms. 5.3 Peripheral Neuropathy: The majority of peripheral neuropathy adverse reactions were Grade 1 (18% in the NINLARO regimen and 14% in the placebo regimen) and Grade 2 (8% in the NINLARO regimen and 5% in the placebo regimen). Grade 3 adverse reactions of peripheral neuropathy were reported at 2% in both regimens; there were no Grade 4 or serious adverse reactions. The most commonly reported reaction was peripheral sensory neuropathy (19% and 14% in the NINLARO and placebo regimen, respectively). Peripheral motor neuropathy was not commonly reported in either regimen (< 1%). Peripheral neuropathy resulted in discontinuation of one or more of the three drugs in 1% of patients in both regimens. Patients should be monitored for symptoms of neuropathy. Patients experiencing new or worsening peripheral neuropathy may require dose modification. 5.4 Peripheral Edema: Peripheral edema was reported in 25% and 18% of patients in the NINLARO and placebo regimens, respectively. The majority of peripheral edema adverse reactions were Grade 1 (16% in the NINLARO regimen and 13% in the placebo regimen) and Grade 2 (7% in the NINLARO regimen and 4% in the placebo regimen). Grade 3 peripheral edema was reported in 2% and 1% of patients in the NINLARO and placebo regimens, respectively. There was no Grade 4 peripheral edema reported. There were no discontinuations reported due to peripheral edema. Evaluate for underlying causes and provide supportive care, as necessary. Adjust dosing of dexamethasone per its prescribing information or NINLARO for Grade 3 or 4 symptoms. 5.5 Cutaneous Reactions: Rash was reported in 19% of patients in the NINLARO regimen and 11% of patients in the placebo regimen. The majority of the rash adverse reactions were Grade 1 (10% in the NINLARO regimen and 7% in the placebo regimen) or Grade 2 (6% in the NINLARO regimen and 3% in the placebo regimen). Grade 3 rash was reported in 3% of patients in the NINLARO regimen and 1% of patients in the placebo regimen. There were no Grade 4 or serious adverse reactions of rash reported. The most common type of rash reported in both regimens included maculo-papular and macular rash. Rash resulted in discontinuation of one or more of the three drugs in < 1% of patients in both regimens. Manage rash with supportive care or with dose modification if Grade 2 or higher. 5.6 Hepatotoxicity: Drug-induced liver injury, hepatocellular injury, hepatic steatosis, hepatitis cholestatic and hepatotoxicity have each been reported in < 1% of patients treated with NINLARO. Events of liver impairment have been reported (6% in the NINLARO regimen and 5% in the placebo regimen). Monitor hepatic enzymes regularly and adjust dosing for Grade 3 or 4 symptoms. 5.7 Embryo-Fetal Toxicity: NINLARO can cause fetal harm when administered to a pregnant woman based on the mechanism of action and findings in animals. There are no adequate and well-controlled studies in pregnant women using NINLARO. Ixazomib caused embryo-fetal toxicity in pregnant rats and rabbits at doses resulting in exposures that were slightly higher than those observed in patients receiving the recommended dose.

Females of reproductive potential should be advised to avoid becoming pregnant while being treated with NINLARO. If NINLARO is used during pregnancy or if the patient becomes pregnant while taking NINLARO, the patient should be apprised of the potential hazard to the fetus. Advise females of reproductive potential that they must use effective contraception during treatment with NINLARO and for 90 days following the final dose. Women using hormonal contraceptives should also use a barrier method of contraception.

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Brief Summary (cont’d) Table 5: Thrombocytopenia and Neutropenia (pooled adverse event and laboratory data) NINLARO + Lenalidomide and Dexamethasone N=360

Placebo + Lenalidomide and Dexamethasone N=360

N (%)

Any Grade

Grade 3-4

Any Grade

Thrombocytopenia

281 (78)

93 (26)

196 (54)

Grade 3-4 39 (11)

Neutropenia

240 (67)

93 (26)

239 (66)

107 (30)

IXAZ17CDNY1359_Brief_Summary_Sept_2017_Update_r3.indd 2

Please see full Prescribing Information for NINLARO at NINLARO-hcp.com. All trademarks are the property of their respective owners. ©2017 Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited. All rights reserved. SEPT 2017

USO/IXA/15/0123(4)

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Herpes Zoster Herpes zoster was reported in 4% of patients in the NINLARO regimen and 2% of patients in the placebo regimen. Antiviral prophylaxis was allowed at the physician’s discretion. Patients treated in the NINLARO regimen who received antiviral prophylaxis had a lower incidence (< 1%) of herpes zoster infection compared to patients who did not receive prophylaxis (6%). Eye Disorders Eye disorders were reported with many different preferred terms but in aggregate, the frequency was 26% in patients in the NINLARO regimen and 16% of patients in the placebo regimen. The most common adverse reactions were blurred vision (6% in the NINLARO regimen and 3% in the placebo regimen), dry eye (5% in the NINLARO regimen and 1% in the placebo regimen), and conjunctivitis (6% in the NINLARO regimen and 1% in the placebo regimen). Grade 3 adverse reactions were reported in 2% of patients in the NINLARO regimen and 1% in the placebo regimen. The following serious adverse reactions have each been reported at a frequency of < 1%: acute febrile neutrophilic dermatosis (Sweet’s syndrome), StevensJohnson syndrome, transverse myelitis, posterior reversible encephalopathy syndrome, tumor lysis syndrome, and thrombotic thrombocytopenic purpura. 7 DRUG INTERACTIONS 7.1 Strong CYP3A Inducers: Avoid concomitant administration of NINLARO with strong CYP3A inducers (such as rifampin, phenytoin, carbamazepine, and St. John’s Wort). 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy: Risk Summary: Based on its mechanism of action and data from animal reproduction studies, NINLARO can cause fetal harm when administered to a pregnant woman. There are no human data available regarding the potential effect of NINLARO on pregnancy or development of the embryo or fetus. Ixazomib caused embryo-fetal toxicity in pregnant rats and rabbits at doses resulting in exposures that were slightly higher then those observed in patients receiving the recommended dose. Advise women of the potential risk to a fetus and to avoid becoming pregnant while being treated with NINLARO. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Animal Data: In an embryo-fetal development study in pregnant rabbits there were increases in fetal skeletal variations/abnormalities (caudal vertebrae, number of lumbar vertebrae, and full supernumerary ribs) at doses that were also maternally toxic (≥ 0.3 mg/kg). Exposures in the rabbit at 0.3 mg/kg were 1.9 times the clinical time averaged exposures at the recommended dose of 4 mg. In a rat dose range-finding embryo-fetal development study, at doses that were maternally toxic, there were decreases in fetal weights, a trend towards decreased fetal viability, and increased post-implantation losses at 0.6 mg/kg. Exposures in rats at the dose of 0.6 mg/kg was 2.5 times the clinical time averaged exposures at the recommended dose of 4 mg. 8.2 Lactation: No data are available regarding the presence of NINLARO or its metabolites in human milk, the effects of the drug on the breast fed infant, or the effects of the drug on milk production. Because the potential for serious adverse reactions from NINLARO in breastfed infants is unknown, advise nursing women not to breastfeed during treatment with NINLARO and for 90 days after the last dose. 8.3 Females and Males of Reproductive Potential: Contraception - Male and female patients of childbearing potential must use effective contraceptive measures during and for 90 days following treatment. Dexamethasone is known to be a weak to moderate inducer of CYP3A4 as well as other enzymes and transporters. Because NINLARO is administered with dexamethasone, the risk for reduced efficacy of contraceptives needs to be considered. Advise women using hormonal contraceptives to also use a barrier method of contraception. 8.4 Pediatric Use: Safety and effectiveness have not been established in pediatric patients. 8.5 Geriatric Use: Of the total number of subjects in clinical studies of NINLARO, 55% were 65 and over, while 17% were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified

differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. 8.6 Hepatic Impairment: In patients with moderate or severe hepatic impairment, the mean AUC increased by 20% when compared to patients with normal hepatic function. Reduce the starting dose of NINLARO in patients with moderate or severe hepatic impairment. 8.7 Renal Impairment: In patients with severe renal impairment or ESRD requiring dialysis, the mean AUC increased by 39% when compared to patients with normal renal function. Reduce the starting dose of NINLARO in patients with severe renal impairment or ESRD requiring dialysis. NINLARO is not dialyzable and therefore can be administered without regard to the timing of dialysis 10 OVERDOSAGE: There is no known specific antidote for NINLARO overdose. In the event of an overdose, monitor the patient for adverse reactions and provide appropriate supportive care. 17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information). Dosing Instructions • Instruct patients to take NINLARO exactly as prescribed. • Advise patients to take NINLARO once a week on the same day and at approximately the same time for the first three weeks of a four week cycle. • Advise patients to take NINLARO at least one hour before or at least two hours after food. • Advise patients that NINLARO and dexamethasone should not be taken at the same time, because dexamethasone should be taken with food and NINLARO should not be taken with food. • Advise patients to swallow the capsule whole with water. The capsule should not be crushed, chewed or opened. • Advise patients that direct contact with the capsule contents should be avoided. In case of capsule breakage, avoid direct contact of capsule contents with the skin or eyes. If contact occurs with the skin, wash thoroughly with soap and water. If contact occurs with the eyes, flush thoroughly with water. • If a patient misses a dose, advise them to take the missed dose as long as the next scheduled dose is ≥ 72 hours away. Advise patients not to take a missed dose if it is within 72 hours of their next scheduled dose. • If a patient vomits after taking a dose, advise them not to repeat the dose but resume dosing at the time of the next scheduled dose. • Advise patients to store capsules in original packaging, and not to remove the capsule from the packaging until just prior to taking NINLARO. Thrombocytopenia: Advise patients that they may experience low platelet counts (thrombocytopenia). Signs of thrombocytopenia may include bleeding and easy bruising. Gastrointestinal Toxicities: Advise patients they may experience diarrhea, constipation, nausea and vomiting and to contact their physician if these adverse reactions persist. Peripheral Neuropathy: Advise patients to contact their physicians if they experience new or worsening symptoms of peripheral neuropathy such as tingling, numbness, pain, a burning feeling in the feet or hands, or weakness in the arms or legs. Peripheral Edema: Advise patients to contact their physicians if they experience unusual swelling of their extremities or weight gain due to swelling. Cutaneous Reactions: Advise patients to contact their physicians if they experience new or worsening rash Hepatotoxicity: Advise patients to contact their physicians if they experience jaundice or right upper quadrant abdominal pain Other Adverse Reactions: Advise patients to contact their physicians if they experience signs and symptoms of acute febrile neutrophilic dermatosis (Sweet’s syndrome), Stevens-Johnson syndrome, transverse myelitis, posterior reversible encephalopathy syndrome, tumor lysis syndrome, and thrombotic thrombocytopenic purpura Pregnancy: Advise women of the potential risk to a fetus and to avoid becoming pregnant while being treated with NINLARO and for 90 days following the final dose. Advise women using hormonal contraceptives to also use a barrier method of contraception. Advise patients to contact their physicians immediately if they or their female partner become pregnant during treatment or within 90 days of the final dose. Concomitant Medications: Advise patients to speak with their physicians about any other medication they are currently taking and before starting any new medications.

Feature

Getting Better All the Time

Fall 2017 FLASCO Conference Inspires and Educates Attendees

he Florida Chapter of the American Society of Clinical Oncology (ASCO), FLASCO, held its 2017 Fall Session at Renaissance Orlando at Sea World on October 20th–21st. The first day of events included a poster presentation on the latest research efforts in the field of cancer studies and treatment, a reception, a dinner and program celebrating FLASCO’s 40th anniversary. ASCO CEO, Clifford Hudis, spoke at the gathering of medical professionals on 40 years of advances in the field of cancer care.

FCS The Magazine

The second day of educational programs emphasized a multi-disciplinary collaboration among healthcare professionals and included presentations of several cancer case studies. Members of the discussion panels also delved into such topics as nursing, patient navigation, pharmacology and administration. Several FCS team members spoke on Saturday’s panels, including Inga Gonzalez, Vice President of Practice Operations; Dr. Eric Harris; Deborah Hawkins, MS, ARNP, AOCNP; Director of Value-Based Care Sierra Tomlinson, RN, MBA, BSN, OCN;

FLASCO | 2017 Fall Session The Florida Society of Clinical Oncology hosted the 2017 Fall Session in Orlando, FL while celebrating their 40th Anniversary. FCS speakers included: Deborah Hawkins, ARNP, Inga Gonzalez VP of Practice Operations, Dr. Eric Harris, Care Management Manager Beth Wittmer and Sierra Tomlinson, RN, MBA, BSN, OCN. Pictured in photo left to right | CMSO Shelly Glenn, Dr. Nalini Hasija, Dr. Michael Diaz, Dr. Eric Harris, Director of Value Based Care Sierra Tomlinson, RN, Associate Director of Care Management Don Champlain, VP of Practice Operations Inga Gonzalez, Care Management Manager Beth Wittmer, RN, and Dr. K.S. Kumar.

FCS Team Participants Dr. Ahmed Al-Hazzouri Sarah Cevallos, CRCO Melody Chang, RPh, MBA, BCOP Dr. Jennifer Cultrera Dr. Uday Dandamudi Dr. Michael Diaz Shelly Glenn, CMSO Dr. Lucio Gordan Dr. William Harrer Dr. Eric Harris

and Care Management Manager Beth Wittmer. Gonzalez participated on the Administrator Discussion Panel; Harris served as moderator on the multi-disciplinary Central Nervous System panel; Hawkins represented nurse practitioners on the Breast Cancer Case Studies panel; Tomlinson spoke on the topic of Workflow Quality Measures on the Transition to Integrating Value-Based Care into Fee-For-Service panel; and Wittmer spoke on the topic of Coordination of Care, also on the Transition panel.

Dr. Nalini Hasija Dr. Maen Hussein Dr. Sachin Kamath Dr. KS Kumar Dr. Daniel Morris Dr. Anjan Patel Dr. Paresh Patel Dr. Shalin Shah Dr. Scott Tetreault Michelle Viveiros, ARNP

Hawkins, who has been a medical professional in oncology for almost three decades, became involved with FLASCO in 2013 when invited to participate in a conference on palliative care. In February 2016, she was asked to give two presentations, one on survivorship and palliative care and one on billing and coding. This was the organization’s first of many Rapid Integration Courses for NPs and PAs who were new to oncology. Since that time, Hawkins has been on the FLASCO planning committee for meetings and most recently sat on one of discussion panels for the fall 2017 session. “For the Fall 2017 conference, I represented Nurse Practitioners on a panel of specialists who work with patients who have breast cancer,” Hawkins says. “The panel included a Nutritionist, a Breast Cancer Navigator, a Geneticist, a Social Worker, a Physical Therapist, a Pharmacist and a Specialist in Clinical Trials. Each specialty presented such a helpful point of view. It makes you wish you could have all of those people together all the time, with every patient you see.” One of the biggest takeaways from her panel, says Hawkins, was the benefit of Clinical Trials. Members of the panel discussed a 1999 case study of a patient with triple negative breast cancer. She received standard treatment but eventually developed metastatic disease. This patient received seven lines of treatment and did well for 17 years. Most of the treatments she received for metastatic disease had not been discovered or were under investigation in 1999. “If it weren’t for Clinical Trials, this person would not have been able to keep working, enjoying her life and traveling,” says Hawkins. “Clinical Trials have extended life. I’ve seen the improvement; I see that things are getting better. People are living better, and that’s what it’s all about. This is a very exciting, dynamic area to work in, and it gets better all the time.” FLASCO Immediate Past President Dr. Michael Diaz, who participated in the conference, stated, “Our physicians, staff and clinicians have been very involved in supporting FLASCO and in leadership roles with this organization. We’re proud to have been a part of the recent conference.”

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Feature FEATURE

On October 12, 2017, FCS hosted the annual Ops Meeting at the Buccaneers Stadium in Tampa, FL. In addition to company updates and team building activities, FCS donated toys and bikes to local patientsâ&#x20AC;&#x2122; children.

Toward Peak Performance Operations Meeting Focuses on Best Practices BY STEVE BORNHOFT

FCS The Magazine

For photos from the event visit | flcancer.com/opsmeeting2017

he 2017 FCS Operations Meeting brought together almost 200 participants including members of the Executive and Senior Management teams, Office Managers, Head Nurses, Clinic Financial Managers and Physician Liaisons. Meeting at the Raymond James Buccaneer’s Stadium in Tampa, the group acknowledged accomplishments of the past year, took note of the status and future of the company and recognized that its success is derived from a combination of passion, proficiencies and talents. Employees were informed that “the company is doing well,” said Todd Schonherz, FCS’s Chief Operating Officer and the facilitator of the conference. “We have seen strong performance and positive results and our team remains bullish about the company’s future and that is exciting.” Schonherz, who has a deep and abiding respect for people who have dedicated their careers to the field of oncology, is often heard to say that his job is not “nearly as difficult as the jobs of our people on the front lines. My role is to do whatever I can to enable people in those positions to succeed.” That is what FCS Operations Meetings are substantially about — discussing ways to channel the passions of employees in the most efficient and effective ways possible. The theme for this year’s conference was “Peak Performance.” In large part, it had to do with the value of collaboration. Twoperson teams made up of a representative of Central Services and one from the practice side of FCS made presentations illustrating how cooperation can yield results that benefit the company, its employees and its patients. Those presentations addressed areas including patient triage and intake, employee engagement, optimizing patient collections and patient recruitment. Schonherz noted, it is possible to calculate the costs associated with those cooperative initiatives versus the benefits derived, especially when they involve operational efficiencies. Taken together, Schonherz said, the presentations represented a collection of “best practices and solutions that will help move our company forward.” The meeting touched upon the evolution within community oncology – the transition from volume to value, a development that FCS has indeed addressed through a team effort involving employees from both the Central Service and practice sides of the company. The conference also addressed topics ranging from patient self-service to company growth strategies and incorporated activities such as team building exercises that included families of FCS patients.

A conference highlight was an appearance by cancer survivor and adventurer Alan Hobson, described by Schonherz as “intriguing and motivational.” As someone who has scaled Mount Everest, Hobson was an especially good fit with the conference’s Peak Performance theme. Indeed, Hobson has been to the mountain three times in expeditions that he organized and guided himself, finally reaching the summit on his third try. Hobson was introduced at the conference as someone who has “scuba dived beneath the ice of frozen lakes in the dead of winter, flown his hang glider 40 miles over jagged mountain peaks and explored the perpetual darkness of subterranean caves. In short, he has been from the top of the world to the bottom. But his greatest adventure has been a massive medical mountain.” At the time of his diagnosis in August 2000 with a highly aggressive blood cancer, acute myeloid leukemia, Hobson learned that 90 percent of the cells in his bone marrow were cancerous. He was 42 and given less than a year to live. Hobson received more than 500 hours of infusion chemotherapy, including 120 hours of high dose chemotherapy, that effectively eliminated his immune system. He then received the modern day equivalent of a bone marrow transplant, an adult blood stem cell transplant. On the day of his transplant, he was so weak from treatment that he could not stand for more than a minute. Today, he is one of a few dozen people in the world ever to have regained an elite level of fitness after an adult blood stem cell transplant for acute leukemia. He recently released a cancer survivorship program for the newly diagnosed. In 2010, Hobson was diagnosed with cancer a second time. But after minor surgery to address squamous cell carcinoma, he was back cross-country skiing within a week. He is now considered to be medically cured and has no lasting significant side effects from either of his cancers or cancer treatments. “My ‘Inner Everests’ have dwarfed the outer one,” he says. “I see life now from a new perspective. Success isn’t about height. It’s about depth — the depth of our experiences and the depths to which we must sometimes reach to climb back from our setbacks in life.” While Hobson’s story and achievements are extraordinary, they served to remind all who attended the Operations Meeting that they contribute every day to the realization of miracles stemming from modern medicine, the combined efforts of FCS employees and the human spirit.

Winter 2018

FEATURE

FCS The Magazine

An Exciting Time for FCS Recapping the 2017 Clinical Summit BY ERIN HOOVER

he Florida Cancer Specialists Clinical Summit is the yearly opportunity for FCS Physicians, Nurse Practioners, Physician Assistants, and Senior Management from across the state to come together to discuss advances in Oncology and Hematology, as well as clinical research opportunities. “It’s one very important and relevant Oncology topic after another,” said Dr. James A. Reeves, Director of Research Operations. “The material covers most of the important subjects and diagnoses that doctors see every day.” The Ritz-Carlton Grande Lakes in Orlando, FL, hosted the meetings and presentations, as well as a Vendor Fair October 27th-29th, 2017. About 250 FCS members attended, including Physicians, Nurse Practitioners, Team Members, Senior Management and Executive Management, along with their families and guests. Olympic Figure Skater and Gold Medalist, Scott Hamilton, kicked off the program by sharing his inspiring story of battling cancer. Hamilton has published two books, The Great Eight: How to Be Happy (Even When You Have Every Reason to Be Miserable and Landing It: My Life On and Off the Ice. He founded the Hamilton Cares Foundation to assist with cancer patient support. The following day, physicians listened to presentations from world experts in many different forms of cancer as part of a Continuing Medical Education (CME) program. The Year-in-Review meeting, developed by Research to Practice under the direction of Dr. Neil Love, provided information on new drugs and treatments, especially in targeted therapy and immunotherapy — a critical forum for learning, at a time of rapid advancement in scientific knowledge. Dr. Manish Patel, who leads the FCS Phase I Drug Development Unit (DDU) in Sarasota, FL, said he was impressed with the newly approved drugs for treatment of leukemia, pointing out that one of the new leukemia drugs, an improved IDH2 inhibitor, was tested by FCS in Phase I Clinical Trials. He also noted advancements in the medical treatment of non-small cell lung cancer in terms of next generation EGFR and ALK inhibitors and the use of PD-L1 inhibitors for gastric cancer and hepatocellular cancer. The Sunday morning program featured discussions about the Clinical Trials program in partnership with Sarah Cannon. “We

talk about the trials we have available, we do a year-in-review, and we talk about trials coming up,” said Katie Goodman, RN, BSN, CCRP, who as Director of Clinical Research is charged with putting together the Sunday program. She said, “We collaborate with Sarah Cannon on what needs to be covered. There is a lot of Q&A. We encourage people to provide feedback on the menu or to talk about challenges they have faced.” Presentations included some of the Phase I Clinical Trials Dr. Patel is working on with Dr. Judy Wang. He noted that the Phase I trials are more complicated than in the past, with more questions asked per trial, and that about 40% of trials are based in immunotherapy. Staff from Sarah Cannon also provided updates on Phase II and III Clinical Trials that occur locally at locations throughout Florida. Goodman said, “I hope that when people leave the meeting they are excited about what they have heard and that they want to go out and offer their patients more trials.” Following the presentations on FCS Clinical Trials program, Dr. Frederick Locke of Moffitt Cancer Center shared advancements in CAR T-cell Therapy, in which a patient’s immune cells are removed and reprogrammed to find and destroy cancer cells. CAR T-cell Therapy represents the cutting-edge of cancer treatment—the FDA only approved the treatment in the last few months. “It’s an exciting time to be an oncologist,” concluded Dr. Reeves. At the Clinical Summit, the FCS team also learn about the latest company news and help honor the humanitarian achievements of their peers. Rather than a single individual, this year FCS chose to celebrate “the nearly 3,000 individuals who have helped to establish a culture of caring” — the FCS team. The award presentation highlighted the efforts of physicians and staff to meet patient needs in the wake of the season’s hurricanes, among other philanthropic efforts. For Dr. Alpana Desai, who practices in Stuart, the summit was a “great opportunity to network and recharge.” The summit was of particular interest to her given her service as a principal investigator in Clinical Trials related to breast, colorectal and lung malignancies. “The summit provided valuable information on the latest trends in oncology,” Dr. Desai said.

Winter 2018

FCS

Events 1.

1. ON OCTOBER 21, 2017, FCS SPONSORED THE FACS ACO SUMMIT. Representing FCS was Elizabeth Rivera-Maloziec, RN Head Nurse; Lynn Sawyer, Regional Director; and Terri Gross, Office Manager from Region 26, Winter Park, Fl.

2. GIFT BAG DONATION | JILL LOWE On October 18, 2017, Jill Lowe donated gift bags filled with journals, adult coloring books, coloring pencils, pens, lotion, comfortable socks, hard candy and an inspirational quote at the Tampa Cancer Center. Pictured in photo left to right | Senior Physician Liaison Monica Tyler, FCS Foundation Executive Director Lynn Rasys, Sr. Office Manager Helga Vonâ&#x20AC;&#x201C;Grieff, Mr. Lowe, Jill Lowe, and Regional Director of Operations Sam Watkins.

FCS The Magazine

3. SPRING HILL PATIENT APPRECIATION EVENT On November 3, 2017, the Brooksville Annual Patient Appreciation BBQ attracted nearly 600 FCS patients. Pictured left to right | Director of Radiology Levester Jones, Dr. Shilen Patel, Amy Gallagher ARNP, Dr. Vikas Malhotra, Samantha DeVry (MA), Ann Bute ARNP, Dr. Thomas Tang and Dr. Mary Li.

4. SISTER HAZEL FUNDRAISER, GAINESVILLE, FL | FCS FOUNDATION EVENT On November 5, 2017, the FCS Foundation partnered with Camp Hazelnut and Sister Hazel to raise funds for cancer patients in need. Pictured left to right | Dr. Vijal Patel and Ken Block from Sister Hazel.

FCS

Events 5.

6A.

6B.

6C.

Submit your recent event photos to FCS Marketing at Marketing@FLCancer.com.

5. HIGHLAND GROUP AT LILLY FUNCTION | NOVEMBER 2017 Back row left to right: Norman Leslie, Tina Bardine, Heather Blanchette, Holly Edmondson, Andrea Hall, Barri Rowland, Alma Ballard, Cindy Goldsworthy and Nancy Nolan. Front row left to right: Adissa Wassmer, Chris Thibodaux, Brett Rousseau, Betsy Mercer, and Ken Copeland.

6. HALLOWEEN Thank you to everyone who participated in the Halloween costume contest at the Corporate Office! To view all photos from Halloween participation at each location visit www.flcancer.com/halloween2017. 6A. Team – Shark Week – Care Management 6B. First Place Winner– “Cherry- O! Spit Spot – Mary Poppins (aka Renee Pearl). 6C. Second Place Winner - “Party with the Mad Hatter” - (aka Stacy Bartley).

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Events 9. 7.

8A2.

7. WOUNDED WARRIORS TAILGATE | TAMPA CANCER CENTER FCS joined the Tampa Bay Buccaneers in honoring military veterans, especially wounded warriors and their families, at the Bucs game on November 12, 2017 with guest speaker Brian Ford, COO of TB Buccaneers. Prior to the game, a celebratory Tailgate Party was held at the Tampa Cancer Center, where FCS patients and staff, vets and Bucs fans gathered for great food, games and giveaways, as they got ready to cheer on their favorite NFL team. As a Tampa Bay Buccaneers sponsor, Florida Cancer Specialists is proud to support the Wounded Warriors Project and to honor the men and women who have so bravely sacrificed for our nation.

8. BLANKET WARMER DEDICATION | SARASOTA DOWNTOWN On November 16, 2017, the Sarasota Downtown location hosted a Blanket Warmer Dedication in honor of patient’s spouse, Janice Berrier. The act of generosity from Janice Berrier will make getting warm a lot easier for our patients.

FCS The Magazine

Pictured left to right | VP of Practice Operations Jeff Rubin, Dr. Chu, Office Manager Robin Spalvins, Patient’s Spouse Janice Berrier, Assistant Office Manager Tabatha Brown and CMSO Shelly Glenn.

9. WINE, WOMEN & SHOES, LAKE MARY, FL | FCS FOUNDATION EVENT On November 4, 2017, the FCS Foundation hosted over 200 guests at the Westin Lake Mary for a charitable evening of fun, fashion and fundraising. The event raised over $70,000 with 100% of donations (net of events) benefiting cancer patients in need. Pictured left to right | FCS Foundation Lead Volunteer Terri Prechtl, FCS CMSO and FCS Foundation Board Member Shelly Glenn and FCS VP of Practice Operations Inga Gonzalez.

Shrinking margins have pushed independent specialty practices to place even greater focus on operational efficiency. In response, successful practices have turned to their GPO and distribution pa rtner for custom ized inventor y management, as well as integrated technologies and business consulting, to increase time with patients. Improving cash f low takes a streamlined workf low. It takes AmerisourceBergen.

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SPECIALTY PHARMACY Winter 2018

Erica Kranz, RN, with daughters Madison and Kaitlyn.

FCS The Magazine

NURSE SPOTLIGHT

Erica Kranz, R.N. Nurse Spotlight | Brooksville BY LAURA CASSELS

rica Kranz, a child of health-care workers, always knew where her path led. It may have been in her genes. It was certainly in her nature. She wanted to become a nurse. She started as a candy striper, became a secretary in a hospital, and now is an Oncology Charge Nurse with Florida Cancer Specialists. A Registered Nurse, Kranz manages a team of 10 nurses at the FCS Brooksville Clinic in Spring Hill that treat 70–100 patients a day. She grew up in this area, graduated from the local community college and got her first job at the local hospital. “Both of my parents were in health care. I grew up around it, and I’m a nurturer by nature,” Kranz said. Being instinctively kind, compassionate and helpful are foundational traits for being a good nurse. At age 13, Kranz embarked on what is, for many, the first step toward a nursing career: She became a candy striper, or a uniformed volunteer who performed non-clinical roles at the hospital where her parents worked. Reporting for duty with her parents at 8 a.m. didn’t bother this teenager, though her two sisters didn’t understand what she saw in it. Kranz studied at Pasco-Hernando Community College (now State College), graduated and took a job at Oak Hill Hospital, where she worked as a secretary and then as a monitor tech on the cardiac floor. She worked at Oak Hill for 10 years, and she credits her time there for the relationships she built and the good training she received. She got married. She and her husband had two children, both girls. Kranz’s skills and her reputation continued to grow, and she was increasingly in contact with patients who had cancer. Eventually, she was recruited, though she waited for the right time. She joined Florida Cancer Specialists five years ago. “This field is so rewarding. It’s an honor to be with the patients for those periods of time, however long,” Kranz said. “The patients all have stories. The relationships we build in this treatment room are deep.” Delivering the best available treatment to sick people for whom you have compassion is a calling that summons and fulfills her, she said. She sees it in fellow nurses.

“I have an amazing nursing team,” she said, leaning hard into the word “amazing.” They personify the creed that nothing is more important to a good nurse than the patient she is treating at the time. She recalled a nurse on her team telling a patient, “I get to take care of you today.” Not “I will be taking care of you,” but “I get to.” She encourages new nurses coming to the team to follow that lead. “I would say, don’t get so busy with all that’s going on that you don’t take time to really understand what’s going on with your patient — the patient in front of you,” Kranz said. “You want them to leave better than they came in.” Extending compassion and guidance to patients’ loved ones is another important part of the job, she said, because patients and their caregivers are fighting the same battle. Where she encounters in patients or their loved ones fear, anger, grief, bitterness, surrender or courage, she responds with kindness, truth and competence. “As their nurse, you are the manager of their care, and they rely on you as a source of strength,” Kranz said. “You have to know your role in that person’s life. It’s about helping who you can in any way you can. Kranz said that the caring nature of nurses works best in excellent clinical settings where the right medicines, stateof-the-art equipment, carefully devised clinical trials and continuing education are all in a day’s work. A large company, FCS has such resources. “FCS strives for the best,” Kranz said, pointing to a new PET/CT scanner in her clinic as evidence of the company motto: “World-class Medicine, Hometown Care.” She is proud that FCS can support clinical trials and research that leads to new therapies that hold promise for patients. “We are actively working on research regimens, and some new medications have come out of it,” she said. It all comes full circle for Kranz: hometown girl who followed in her parents’ footsteps and is living her dream to deliver the best available care to sick people she cares about. With daughters Kaitlyn, 9, and Madison, 8, watching, she intends to be a good role model, as her role models were for her.

Winter 2018

OFFICE SPOTLIGHT

Settling In

New North Fort Myers Office is Bigger & Better Than Before BY KIM HARRIS THACKER

n a sunny, newly developed stretch of Pine Island Road stands the new Florida Cancer Specialists North Fort Myers office, which opened July 31, 2017. It contains 78 chairs in the treatment room and houses 18 healthcare providers and numerous staff. Services offered to FCS patients at this site include medical oncology, hematology, radiology, Care Management, pathology, lab services and Rx To Go. North Fort Myers Senior Office Manager Debbie Wiseman, who has been working with FCS for the past 20 years, says she sees the new office as a representation of the changes the company has undergone since she “first started in the chart room at the old Broadway office.” “Over 20 years, the company has grown many times,” she says. “You used to be able to count on your hands how many doctors we had, and now there are more than 200. Our previous office was much smaller than this one, with about 15 staff members.” Helping to ensure that communication and the needs of the team are met is Anne Ronco, Associate Regional Director of Operations for the Lee County Offices. “Anne was a great help to us in transitioning from our old office to this new one because she moved to a new office herself last year,” Wiseman says. “She gave us some great tips, and they helped us to save time setting everything up. We also had a team day prior to opening, when all of the staff spent a few hours at the new office so that they could

FCS The Magazine

familiarize themselves with the building and get to know their new teammates. The result was that the opening went much more smoothly than any of us could have ever hoped.” All in all, Wiseman says that the members of the North Fort Myers staff have settled into their roles and are beginning to find the best ways to work together. “Teamwork is extremely important to our goal of taking care of patients and doing it well,” she says. “Working at this new location is definitely a new challenge for me in my career with FCS; but we have a great team here of seasoned employees and newcomers that I feel very honored to work with.”

North Fort Myers Clinic Info Address: 1030 Commerce Creek Blvd., Cape Coral, Florida 33909 Call: (239) 997-3081 Fax: (239) 997-3084 Web: flcancer.com/en/location/north-fort-myers Hours: M–F, 8 a.m.–5 p.m.

North Fort Myers Who’s Who Administration • Anne Ronco, Associate Regional Director of Operations • Debbie Wiseman, Senior Office Manager

Physicians • Liliana Bustamante, MD (new; started in August) • Raymond Esper, MD, PhD • Faithlore Gardner, MD • Michael J. McCleod, DO • Van G. Rana, MD • Michael G. Raymond, MD • Frank Rodriguez, MD • Silvia A. Romero, MD • Syed F. Zafar, MD

ARNPs and PAs • Danielle Francis, ARNP • Laraine Mouthaan, ARNP • Debbie Slipkovich, DNP, ARNP • Dee Steed, PA • Edward Green, ARNP • Chris Jijon, PA • Nicole Scott, PA • Jenna Thibodeau, PA • Julissa Taverez, ARNP

Winter 2018

Tara Ruska, CPA, MSAT, and son Gavin.

FCS The Magazine

SENIOR MANAGEMENT SPOTLIGHT

‘Living the Dream’

Senior Management Team Member Tara Ruska, CPA, MSAT, Balances Life and The Books BY KIM HARRIS THACKER

“

My mother always wanted one of her kids to be a doctor,” says Cape Coral native Tara Ruska, “I’m as close as she’s going to get.”

It’s not that Ruska isn’t interested in medicine; quite the contrary, in fact.

“The medical field is always evolving, which makes it extremely interesting,” she says. “Even though I’m not on the patient side of the business, it is exciting to be part of the whole process.” The side of the business that Ruska works on is the financial side. Prior to joining FCS in 2014, she worked as a Certified Public Accountant, providing tax and consulting services at a regional firm. Her consulting services consisted primarily of physician compensation models, internal controls reviews and general business consulting and advice services. The majority of the clients who benefited from Ruska’s expertise were involved in the medical industry, and Florida Cancer Specialists was one of them. “I worked with FCS for 10 years prior to joining as Controller in 2014,” Ruska says. “Now, I work at the corporate office of FCS along with a great team of approximately 25 people. Some days I’m at my desk all day, crunching numbers, but most days I’m in meetings working with other departments on various projects, such as finding greater efficiencies and exploring vendor relationships for better service and cost-saving opportunities. I spend a significant amount of time working on our physician compensation model and reviewing financials.” Ruska describes her work at FCS in three words: challenging, supportive and collaborative. Her main challenge, she says, is not having enough time in the day to complete all of her tasks. But it’s a challenge she tackles with determination and the help of her team. “We are always working toward figuring out how to do things more efficiently and quickly,” she says. “When I started here, we did everything manually. We do a lot more things through

automation or by computer now — which means there’s less error and it’s more efficient. But there’s always room for improvement. It’s a challenge to keep everything accounted for and tracked at work, and to do it all in a timely manner. FCS is ever changing, and some days it’s harder than others to keep my head above water, but I have a fantastic team that I can rely on. I wouldn’t be able to do my work without them. Everyone takes a lot of pride in their job and their work, which is evident in all they do.” Like most people, Ruska also works hard to balance her employment with her home life and personal needs. “I’m the single parent of a young son, and it’s challenging to fit everything in during the day,” she says. “Yes, I work at the FCS Corporate Office, but I also work at home. I get my sevenyear-old son and myself up and out of the house each day — when neither of us is a morning person — get him to Cub Scouts on time, pick him up on time. A day in my life is hectic!” Hectic, yes, but Ruska says she is “living the dream.” “Some days I say that very sarcastically; other days, it’s true,” she explains. “To me, living the dream is about keeping things in perspective. Some days I do feel like I’m living the dream. Then there are the hard days. On those days, I have to step back and recognize that I have a great son and a great job with a great company.” What she most admires about FCS is the organization’s commitment to patients and to cancer research. “We’re always looking for ways to help cancer patients,” Ruska says. “We put the patients first. In accounting, we may not be working directly with the patients, but we work with the doctors and staff. We’re not on the ‘front lines,’ per se, but we’re definitely an important part of the practice.” To be recognized as an important member of a team is what makes a person feel valued — or in Ruska’s words, it’s what makes a person feel like they are “living the dream,” no matter what.

Winter 2018

FEATURE

Hurricane Help

FCS Lends a Helping Hand and Financial Resources to Relief Efforts in Florida, Texas and Puerto Rico BY KIM HARRIS THACKER

FCS The Magazine

Pictured in photo left to right | CMSO Shelly H. Glenn, Physician Liaison Kay Simpkins, Dr. Muhammad Imam, Dr. Meera Iyengar, CEO Brad Prechtl, Regional Director of Operations Lynn Sawyer, Senior Physician Liaison Rhonda Webster and Associate Regional Director of Operations Annie Pigue.

ugust 25th, September 10th, September 20th. These dates late in the Summer of 2017 will live in the memories of Texans, Floridians and Puerto Ricans for many years to come. On August 25th, 2017, Hurricane Harvey deluged low-lying Houston with upwards of four feet of rain, sending floodwaters into nearly every corner of Space City. Hurricane Irma, one of the strongest storms ever to strike the U.S., engulfed the entire state of Florida, making landfall on September 10th, 2017. It was downgraded to a tropical storm the next day, and still brought heavy rain and vicious winds that caused flooding, damage to buildings and wide power outages across the state. Hurricane Maria, the last and strongest of the storms of the 2017 hurricane season, plowed across Puerto Rico on September 20th, 2017, turning the majority of that U.S. territory into ruins. When events like these take place, it is the elderly, the young and the sick who tend to suffer the most. Knowing this, Florida Cancer Specialists has demonstrated that team members are ready and willing to help alleviate suffering wherever and however they can. Almost immediately after Hurricane Harvey hit Texas, FCS stepped in, sending financial assistance and supplies to the state. “Our physicians and staff have been extremely generous, giving financial support to a number of hurricane relief initiatives,” said Brad Prechtl, FCS CEO. As the product of planning and preparation, 80 to 85 percent of FCS locations were open within 48 hours after Irma passed through Florida. Some locations were consolidated into one. Todd Schonherz, Chief Operating Officer at FCS, explained that the consolidation plan was created before the storm’s arrival to ensure that severe weather wouldn’t prevent a patient from receiving cancer treatment. “If our patients needed to be reassigned or moved someplace else, we coordinated that,” said Schonherz. “We were also able to work with our drug suppliers to make sure our patients received the medications they needed. Our patients are our priority.” Schonherz said many FCS employees who live in areas that were compromised by the storm demonstrated their commitment to patient care by doing whatever was necessary to come to the office once the storm had passed, even though dozens of these employees were without power in their homes. After Hurricane Maria devastated Puerto Rico, FCS brought many cancer patients who had been receiving treatments from oncologists on the island to FCS facilities in Florida, where they continued to receive treatment. “We worked mostly with Community Oncology Alliance (COA) to coordinate the relief efforts,” Dr. Lucio Gordan said. “Patients could have come to any of our almost 100 locations; it depended on their needs, if they had family locally, or their means of transportation.” Not only did FCS bring cancer patients from Puerto Rico to the mainland, the organization also shipped pallets of non-medical supplies to the island. These supplies were valued at more than $5,000 and included water, canned food, baby formula, diapers and wipes, first aid kits, toothbrushes and more. Other aid-related projects are currently underway, and more are planned for the near future. “Storms of a magnitude that struck the United States during 2017 were a lot like cancer, itself,” said Schonherz. “Countless people were affected in addition to the immediate victims, themselves. At FCS, we aim to help lift burdens wherever we can.”

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Into the Storm “I believe we track the weather better than Doppler radar. Even before the storm made landfall, touched the ground or blew through town, we had already coordinated with our sales team and customers to be on standby for an uncoventional delivery of their supplies. As soon as we knew what customers had been affected by the storm and determined if we could feasibly get to them, we hand-delivered the orders to the Distribution Center team. We loaded up our cars with the boxes, got gas and headed out. Our shipping companies might not have been able to get through, but we drove overnight, into the storm, to make sure our patients didn’t miss their treatment the next day.” Because at Oncology Supply, we believe a cancer patient should only have to battle one storm at a time. – S. Vaughn Supervisor, Customer Setup Oncology Supply (15 years)

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ti n g

o Pro m

a li n g

r As a Te ethe am g To

a lt h, H o p e a

Florida Cancer Specialists would like to give a BIG thank you to our valued sponsors of the 2017 FCS Clinical Conference that was held for the Nurses and Clinic Pharm-Techs on December 2nd, 2017 at the Tampa Airport Marriott, in Tampa, FL. KEYNOTE SPEAKER:

SPEAKERS:

FLCancer.com

Winter 2018

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