Inspired WINTER 2015
A PHYSICIAN PUBLICATION
ALSO IN THIS ISSUE PAGE 1
Deep-inspiration breath hold (DIBH) technique protects heart, lungs during radiation therapy for breast cancer PAGE 8
Radical vaginal trachelectomy preserves fertility of patient with cervical cancer SPECIAL INSERT
Quality and Safety Report
EVALUATING FAMILIAL GI CANCER RISK New clinic provides risk assessment, genetic counseling and prevention strategies
The University of Chicago Medicine & Biological Sciences has been at the forefront of medical care, research and teaching for more than 90 years. Located ÂŽ
AT T H E F O R E F R O N T O F M E D I C I N E
in historic Hyde Park on the South Side of Chicago, the University of Chicago Medicine & Biological Sciences includes: Patient Care  Center for Care and Discovery  Comer Children’s Hospital  Bernard A. Mitchell Hospital  Duchossois Center for Advanced Medicine  Numerous outpatient locations throughout the Chicago area Teaching Programs  Pritzker School of Medicine  Master’s and doctoral degree programs  Postdoctoral programs Research  Medical and basic science units Among our many honors and acknowledgments: 12 Nobel laureates; ranked 11th of all U.S. medical schools; one of only 41 National Cancer Institute–designated comprehensive cancer centers; ranked fifth in nation for National Institutes of Health grant support per researcher. University of Chicago Medicine & Biological
Our GI Cancer Risk and Prevention Clinic focuses on translating today’s advances in genetics research into early detection and prevention strategies.
Sciences Executive Leadership Kenneth S. Polonsky, MD, Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago
DEAR COLLEAGUES,
Sharon O’Keefe, president of the University of Chicago Medical Center
Upon hearing a
You will also read about our expertise in
affairs, University of Chicago Medicine
cancer diagnosis,
specialty women’s care with an emphasis
T. Conrad Gilliam, PhD, dean for
patients often ask
on urogynecology, gynecologic oncology
their physicians two
and sexual health after cancer. The
questions: “Why did
three stories on pages 8 and 9 detail
this happen to me?�
some of the innovative care we offer for
Jeffrey Glassroth, MD, dean for clinical
basic science, Biological Sciences Division Holly J. Humphrey, MD, dean for medical education, Pritzker School of Medicine INSPIRED IS PUBLISHED THREE TIMES A YEAR BY THE UNIVERSITY OF CHICAGO MEDICINE & BIOLOGICAL SCIENCES. Editor: Anna Madrzyk Assistant Editor: Gretchen Rubin Email us at: inspirededitor@uchospitals.edu Design: TOKY Branding + Design
and “Are my family members also at risk about familial cancer syndromes, we
Finally, we are honored to share
are able to answer these questions with
the quality and safety recognitions
increasing accuracy.
we’ve received from several national organizations. A special report inside
Contributing writers Mary Buschmann, PhD, Thea Grendahl
challenging and complex conditions.
for developing cancer?� As we learn more
Our Gastrointestinal Cancer Risk and
outlines some of our initiatives for
Greenwood, Felicia Hudson, Kevin Jiang,
Prevention Clinic focuses on translating
improving the patient experience.
Jane Kollmer, Michael McHugh, Gretchen
today’s advances in genetics research into
Christou, John Easton, Sarah Fell, Cynthia
Rubin, Tiffani Washington, Matt Wood Contributing photographers David Christopher, Bob Coscarelli, Robert Kozloff, Jean Lachat, Matt Wood ADDRESS The University of Chicago Medicine
early detection and prevention strategies.
As always, we are committed to your
In this issue of Inspired, we update you
experience and satisfaction as well. We
on assessment, testing and management
look forward to collaborating with you.
of gastrointestinal cancer syndromes.
5841 S. Maryland Ave., Chicago, IL 60637 The University of Chicago Medicine Comer Children’s Hospital 5721 S. Maryland Ave., Chicago, IL 60637 Telephone Appointments Follow the University of Chicago Medicine on Twitter at twitter.com/UChicagoMed or visit our Facebook page at facebook.com/ UChicagoMed. You can read more about our news and research at uchospitals.edu/news and at sciencelife.uchospitals.edu. This publication does not provide medical advice or treatment suggestions. If you have medical problems or concerns, contact a physician, who will determine your treatment. Do not delay seeking medical advice because of something you read here. For urgent needs, call 911 right away. Read Inspired online at uchospitals.edu/inspired.
KENNETH S. POLONSKY, MD Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago
AT THE FOREFRONT OF WOMEN’S AND CHILDREN’S CARE VASCULAR ANOMALIES
DIBH
Comprehensive care, second opinions for vascular anomalies
Radiation therapy technique spares heart, lungs
The University of Chicago Medicine Comer Children’s Hospital provides coordinated care for babies and children with complex vascular anomalies. These congenital lesions include hemangiomas; lymphatic, venous and arteriovenous malformations; and rare vascular tumors, which can form in the skin, bones, liver, lungs and extremities. Kaposiform hemangioendothelioma (KHE) is one type of rare, sometimes fast-growing vascular tumor that may occur during infancy or early childhood. Depending on the patient’s symptoms and the extent of the lesions, treatment may include medications to slow tumor growth, surgery and/or chemotherapy. Comer Children’s Hospital recently organized a multidisciplinary team to evaluate and manage patients with vascular anomalies, including KHE and other rare tumors. The team includes pediatric experts in surgery; cardiology; dermatology; genetics; diagnostic, interventional
and neurointerventional radiology; neurovascular surgery; otolaryngology; plastic surgery; and hematology/ oncology. Under the leadership of Jessica J. Kandel, MD, these physicians discuss diagnoses, share viewpoints and develop individualized treatment plans. As a primary referral center in the Midwest, the Vascular Anomalies Program at Comer Children’s Hospital serves as a resource for pediatricians, dermatologists and surgeons looking for specialty evaluation, second opinions on diagnosis or treatment plans and a comprehensive multidisciplinary program. Kandel and other researchers on the team also study vascular anomalies in order to advance treatment options for patients with these disorders. “At present, we have developed a model of lymphatic malformations that allows us to test the effects of different drugs on these lesions,” she said. “Our goal is to better understand the molecular drivers that underlie these responses.”
Patients receiving radiation therapy for left-sided breast tumors while lying chest up are at greater risk for radiation exposure to the heart and lungs. But a technique known as deep-inspiration breath hold (DIBH) moves the heart and lungs away from breast tissue and as far out of the radiation field as possible by having patients breathe deeply and briefly hold their breath during treatment. “This method gives patients the best chance of curing their cancer, because the full clinical target is treated while reducing the side effects of radiation to their heart and lungs,” said medical physicist Hania Al-Hallaq, PhD. To make DIBH easier for the patient, our radiation oncologists use a state-of-theart system that relies on 3D surface imaging to detect the breast’s position for accurate treatment. This highly sensitive technology delivers radiation only during optimal positioning and shuts off automatically when the patient coughs or exhales. Unlike older DIBH technology, this system does not require the patient to breathe into a device during treatment.
The University of Chicago Medicine was the first Chicago-area hospital to offer DIBH using this innovative technology. With the addition of this treatment option, our radiation oncologists have the latest technologies available to treat each individual patient as effectively as possible without harming nearby organs. “I am proud of the work our team has done to ensure that women treated at the University of Chicago Medicine can have the most sophisticated radiotherapy to combat the disease and prevent potential side effects,” said radiation oncologist Steven J. Chmura, MD, PhD. | B E L OW | The DIBH technique (bottom image) moves the heart and lungs as far out of the radiation field as possible during treatment.
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Research News UNIVERSITY OF CHICAGO TO ESTAbLISH GENOMIC DATA COMMONS NEW DRUG qUASHES CANCER CELLS
A new drug eradicates aggressive human lung cancers transplanted into laboratory models. University of Chicago Medicine researchers had identified a protein produced by a wide range of human cancers that is believed to promote tumor growth. The drug they developed, OTS964, inhibits the activity of this protein, leaving cancer cells unable to complete the cell division process. When taken orally, the drug was well tolerated with limited toxicity. An intravenous form, delivered within a liposome, had fewer side effects. Both approaches led to complete regression of transplanted tumors. Study author Yusuke Nakamura, MD, PhD, called the results “rare and exciting.” The researchers, who published their results in Science Translational Medicine, are working with oncologists at UChicago Medicine to begin a phase 1 clinical trial as soon as the summer of 2015.
NAKAMURA
The University of Chicago is collaborating with the National Cancer Institute to establish the nation’s most comprehensive computational facility that stores and harmonizes cancer genomic data generated through NCI-funded research programs. The NCI Genomic Data Commons (GDC) will expand access for scientists around the country, speeding up research and, in turn, leading to faster discoveries for patients. The GDC will provide an interactive system for researchers, making the data easier to use; it also will provide resources to facilitate the identification of subtypes of cancer as well as potential therapeutic targets.
READ MORE AT
ScienceLife.uchospitals.edu GROUNDbREAkING STUDY
A University of Chicago Medicine study of early physical and occupational therapy in critically ill patients has been selected as one of the 15 most significant randomized controlled physiotherapy trials ever published. The Centre for Evidence-Based Physiotherapy invited therapists to nominate groundbreaking trials, which were judged by a panel of international experts. The study changed standards of care by demonstrating that caregivers could engage patients, even those on a ventilator, “in aggressive physical and occupational therapy, including out-of-bed activity very early in their hospital stay, and that the patients who did so showed superior outcomes,” said Amy Pawlik, PT, DPT, CCS, an author of the study published in The Lancet in 2009. “Our study helped change the way we manage patients with critical illness. It is becoming the standard of care in the United States and internationally.”
2 » THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | WINTER 2015
“The Genomic Data Commons has the potential to transform the study of cancer at all scales.” RObERT GROSSMAN, PHD
“The Genomic Data Commons has the potential to transform the study of cancer at all scales,” said Robert Grossman, PhD, director of the GDC project and professor in the Department of Medicine. “It supplies the data so that any researcher can test ideas, from comprehensive ‘big-data’ studies to genetic comparisons of individual tumors to identify the best potential therapies for a single patient.” Read more at uchospitals.edu/ genomic-data-commons.
PREDICTING A TUMOR’S RESPONSE
Mining genomes’ vast information has uncovered signs about how well a patient may respond to chemotherapy. University of Chicago Medicine researchers collected data from almost 700 cell lines about dozens of tumor types, including sensitivity to almost 140 different drugs, as well as their whole-genome gene expression. R. Stephanie Huang, PhD, and her colleagues built a computational tool that estimated the contribution of each gene and utilized their combined effect to predict a tumor’s sensitivity toward a drug. Analyzing tumors from actual patients, the researchers were able to predict a tumor’s response to the drug with roughly 70 to 90 percent accuracy. The researchers are working to improve their model and are collaborating with oncologists to test and prove its utility in clinical trials. Results were reported in the journal Genome Biology. FOLLOW US ON TWITTER
@ScienceLife
NEW OPTIONS FOR CANCER TREATMENT MAK
Hyperthermic intraperitoneal chemotherapy (HIPEC) now offered for pediatric patients The University of Chicago Medicine Comer Children’s Hospital is one of only a few medical centers in the United States offering hyperthermic intraperitoneal chemotherapy (HIPEC) for children, adolescents and young adults who have advanced abdominal tumors.
Outpatient blood and bone marrow stem cell transplantation available for select patients The University of Chicago Medicine is now offering outpatient blood and bone marrow stem cell transplantation to patients who are diagnosed with multiple myeloma and are appropriate candidates for an autologous transplant. The same team of physicians and nurses who provide inpatient blood and bone marrow stem cell transplant care oversee the outpatient program. Patients undergo the full treatment course (pre-transplant evaluation, conditioning, infusion of their stem cells, engraftment and recovery) on an
Patients with cancers that affect or spread to the peritoneum are particularly good candidates for HIPEC treatment. The most common peritoneal cancer in children and young adults is desmoplastic smallround-cell tumor (DSRCT), a rare and aggressive cancer that affects about 200 patients in the U.S. each year. Patients with the best outcomes are those who have had complete surgical resections by a skilled peritoneal surgeon combined with HIPEC. | A B O V E , R I G H T | Pediatric surgeon Grace Mak, MD, and pediatric hematologist/ oncologist Navin Pinto, MD, lead the multidisciplinary HIPEC team.
PINTO
HIPEC TREATMENT
Immediately following surgical removal of all visible abdominal tumors, a heated chemotherapy agent is delivered directly into the patient’s peritoneal cavity via catheter. The goal of HIPEC is to eradicate any small tumor deposits that cannot be seen by the surgeon. Because HIPEC is not absorbed into the bloodstream, it has few effects on the rest of the body. Unlike traditional chemotherapy, HIPEC is a high-concentration solution administered in a single treatment. The process typically takes between 1½ and 2 hours.
For more information or to refer a patient, please call 773-702-6808.
Outpatient SCT is offered to select patients who meet the following criteria: » Diagnosed with multiple myeloma and a candidate for an autologous transplant.
» < 60 years of age (in most cases). » No evidence of heart disease or kidney disease.
» Live within an hour’s drive of the UChicago Medicine campus or willing to convalesce at a designated hotel near campus.
» Have a responsible, designated caregiver who will be with the patient 24/7. This caregiver does not need medical training.
» Patient and caregiver agree to follow infection prevention guidelines.
» No pets or young children living in the home during the treatment process.
outpatient basis rather than being admitted for three to four weeks. The patient and a designated caregiver make daily visits to the University of Chicago Medicine outpatient blood and bone marrow transplant unit on the 10th floor of the Center for Care and Discovery. If hospitalization is necessary, patients are easily transitioned into our dedicated inpatient unit. In the future, outpatient blood and bone marrow stem cell transplantation will be available to patients with lymphoma and for allogeneic transplants.
For more information or to refer a patient, call 855-702-8222.
AT THE FOREFRONT
Many patients report that being with family and friends at home is beneficial to their overall state of mind during treatment.
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CONFERENCE DIGEST American College of Gastroenterology
American Society of Human Genetics
San Antonio Breast Cancer Symposium
David T. Rubin, MD, section chief of gastroenterology, hepatology and nutrition, and co-director of the Digestive Diseases Center, was elected to the American College of Gastroenterology Board of Trustees at the ACG 2014 Annual Scientific Meeting in Philadelphia in October. Rubin gave three presentations, including “How and When to Screen for Cancer in IBD.”
Nancy Cox, PhD; Olufunmilayo Olopade, MD; Jane Churpek, MD; Yoav Gilad, PhD; Anna Di Rienzo, PhD; and Chuan He, PhD, gave poster and/or oral presentations at the American Society of Human Genetics Annual Meeting in Boston in October.
Olufunmilayo Olopade, MD, served as a panelist for the “Role of Advocates in Community, Research and Policy” discussion at the San Antonio Breast Cancer Symposium in December. Dezheng Huo, MD, PhD; Geoffrey Greene, PhD; Rita Nanda, MD; Aasim Padela, MD; and Swati Kulkarni, MD, gave presentations on their latest findings.
Two University of Chicago Medicine physicians led hands-on workshops: Carol Semrad, MD (small bowel enteroscopy) and Uzma Siddiqui, MD (endoscopic ultrasound).
American Association for the Study of Liver Diseases University of Chicago Medicine presenters at the American Association for the Study of Liver Diseases 2014 Liver Meeting in Boston in November included Nancy Reau, MD; Helen Te, MD; Andrew Aronsohn, MD; and K. Gautham Reddy, MD.
AT THE FOREFRONT
The University of Chicago Medical Center IS DESIGNATED
A NATIONAL
EBOLA treatment facility by the U.S. Centers for Disease Control and Prevention. We are one of a select group of hospitals in the country and four in Chicago.
Read more at
American Society of Hematology Many University of Chicago Medicine Comprehensive Cancer Center researchers participated in the Annual Meeting of the American Society of Hematology in San Francisco in December. Speakers, moderators and presenters included Jane Churpek, MD; Michelle M. LeBeau, PhD; Richard Larson, MD; Jianjun Chen, PhD; Y. Lynn Wang, MD, PhD; Chadi Nabhan, MD; Sonali Smith, MD; Hongtao Liu, MD, PhD; Andrew Artz, MD, MS; Amittha Wickrema, PhD; Michael Bishop, MD; Yusuke Nakamura, MD, PhD; Justin Kline, MD; and Wendy Stock, MD.
uchospitals.edu/ebola-designation.
UChicago Medicine committed to expanding pediatric trauma care The University of Chicago Medicine is taking formal steps to raise the age limit of its pediatric trauma program by two years to include 16- and 17-year-old children. Medical center leaders are working with state, county and city officials to increase the age limit of its Level 1 pediatric trauma center at Comer Children’s Hospital, which has been treating seriously injured children since it opened in 2005. “We decided that expanding trauma care to all minor children would help provide an important service
to a particularly vulnerable part of our community,” said Sharon O’Keefe, president of the University of Chicago Medical Center.
“This underscores our commitment to continually meet the needs of children in our South Side community.” O’Keefe said the search for additional physicians and staff who specialize in pediatric trauma care will begin as soon
4 » THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | WINTER 2015
as possible. She expects the pediatric trauma unit will be ready to treat this broader group of patients within a year. The state historically has defined pediatric patients as age 15 and younger under the Emergency Medical Services and Trauma Center Code, adopted by the Illinois Department of Public Health. Correspondingly, pediatric trauma centers in Illinois are certified to treat pediatric patients 15 years and younger. This past summer, the University of Chicago Medicine extended the age of non-trauma patients treated at Comer Children’s Hospital emergency department to include 16- and 17-year-olds.
Stanley Liauw, MD Associate Professor of Radiation and Cellular Oncology
Pat Navin Donor to the University of Chicago Medicine
Everybody has a gift. Stanley Liauw, MD, has a gift for changing patients’ lives. Take Pat Navin. Diagnosed with an aggressive form of prostate cancer, he underwent surgery followed by hormone therapy and radiation under Liauw’s supervision. After eight weeks of Monday-through-Friday radiation treatments—to which he bicycled 44 miles round-trip to UChicago from his home in Evanston, Illinois—Navin is now cancer-free. “One thing I’ve really come to appreciate about the medical center is the amount of effort that’s put into research, because that’s where the breakthroughs happen,” he says. In gratitude, Navin turned his daily bike rides into a fundraiser to support Liauw’s research projects, including tracking outcomes for prostate cancer patients to identify factors associated with treatment success and quality of life. Liauw’s work also includes potentially life-changing clinical trials. One involves a new treatment regimen that could save the bladders of patients with bladder cancer; another is testing the delivery of large, precisely targeted amounts of radiation to pancreatic tumors—which are notoriously difficult to treat—while sparing surrounding tissue.
Imagine the impact yours could make. Learn more at givetomedicine.uchicago.edu or call (773) 702-6565.
Gastrointestinal Cancer Risk and Prevention The new Gastrointestinal Cancer Risk and Prevention Clinic at the University of Chicago Medicine offers assessment for patients and families who may be at increased risk for developing gastrointestinal malignancies due to genetic factors. Our genetic counselors and physicians use personal and family history as well as genetic testing to assess gastrointestinal cancer susceptibility for individuals and their family members. Once the risks are determined, we offer: » Cancer prevention counseling
and strategies » Colorectal cancer screening and
Sonia Kupfer, MD, is researching the genetic associations in African-American patients who have colorectal cancer. The National Institutes of Health/National Cancer Institute funded the five-year study.
surveillance, including colonoscopy » Pancreatic cancer screening for
high-risk patients » Gastrointestinal surgical procedures » Cancer prevention in patients
with inflammatory bowel disease (Crohn’s disease or ulcerative colitis) Our team works closely with patients and their primary care physicians to develop strategies for following surveillance and management plans.
» Gastric adenocarcinoma age < 50 and/or
personal or family history of breast cancer Evaluation and risk assessment are recommended for families who have a genetic mutation associated with any of the following cancer predisposition syndromes:
GASTROINTESTINAL CANCER RISK ASSESSMENT CRITERIA
» Lynch syndrome, also called
Evaluation and risk assessment are recommended for individuals who have the following in their medical history:
» Familial adenomatous polyposis (FAP)
» Multiple gastrointestinal polyps
» Peutz-Jeghers syndrome
HNPCC (hereditary nonpolyposis colorectal cancer) » Juvenile polyposis syndrome
» Inflammatory bowel disease, especially
with longstanding colon involvement » Colorectal cancer age < 50 » Colorectal cancer at any age with a
personal or family history of other cancers » Pancreatic cancer at any age with a
For referral assistance, urgent patient transfers and patient appointments or consultations, physicians may call GI Physician Connect at 1-844-824-4362. Appointments are usually available within one to two weeks.
personal or family history of other cancers
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Gastrointestinal Cancer Risk and Prevention Team GASTROENTEROLOGY
Sonia Kupfer, MD Co-director, Comprehensive Cancer Risk and Prevention Clinic David T. Rubin, MD GENETIC COUNSELING
Jessica Stoll, MS, CGC INTERVENTIONAL ENDOSCOPY
Andres Gelrud, MD, MMSc Uzma Siddiqui, MD COLON AND RECTAL SURGERY
Neil Hyman, MD ONCOLOGY
Blase Polite, MD
AT THe FOReFRONT
Our cancer risk patient registry dates back to 1992, when Olufunmilayo i. Olopade, MD, founded the cancer risk assessment program at the University of chicago Medicine. The registry helps our physicians identify new syndromes and develop more effective cancer prevention strategies for patients.
Cancer Risk and Prevention Clinics The University of chicago Medicine offers personalized risk assessment and prevention recommendations for patients and families who may be susceptible to developing several types of cancer. cancers for which mutations have been found and genetic testing is available include: » Breast and ovarian cancer » Gastrointestinal cancers
Researchers at Uchicago Medicine continue to search for genetic mutations that may cause people to be vulnerable to cancer. Our research program takes a multidisciplinary approach to studying cancer genetics of people from various racial and ethnic backgrounds in the U.s. and across the globe. focusing on both clinical and basic science research, our ultimate goal is to increase the speed at which laboratory research is translated into health care practices that directly benefit people, especially those populations that suffer from a disproportionate burden of cancer.
» hematologic cancers » Pancreatic cancers » Pediatric familial cancer syndromes » endocrine tumors, including
those related to von hippel-lindau syndrome » Other familial cancer syndromes,
including cowden syndrome, li-fraumeni syndrome and hereditary forms of melanoma
To read more about our cancer risk and prevention clinics, please visit uchospitals.edu/risk-clinics.
canceR Risk QUiz
1 individuals with a personal or family history of early onset cancer (< 50 years of age) should be referred for cancer risk assessment.
2 chemoprevention is beneficial for management of some individuals with hereditary cancer syndromes.
3 colon cancer that shows microsatellite instability (Msi-h) is always due to an inherited mutation. 4 Personal or family history of colon, endometrial and ovarian cancers at ages over 60 makes a hereditary cancer syndrome very unlikely. 5 health insurers or employers may legally discriminate against individuals based on results of genetic testing. ANSWeRS: 1. True 2. True 3. False 4. False 5. False
clinical cancer genetics is a broad field that spans many specialties. it is also a rapidly changing field — new screening modalities and testing strategies are continuously being developed. Test your knowledge about cancer risk with this quiz for medical professionals:
The Future of Pancreatic Cancer Treatment The Chicago Pancreatic Cancer Initiative — a project funded by Carole and Gordon Segal, founders of Crate and Barrel, and built on work funded by the Michael Rolfe Pancreatic Cancer Foundation — is working to improve outcomes for patients with pancreatic cancer using personalized medicine and genomic information. The goal of the project is to craft pancreatic cancer therapies based on an individual’s DNA, so that a treating physician can examine a patient’s genetic code, learn of unique genetic intricacies specific to the individual and his or her cancer, and select a therapy to aggressively target that patient’s disease. Since the initiative’s inception 18 months ago, the project’s team — led by genomics expert Kevin White, PhD, surgeon Kevin Roggin, MD, and geriatrician William Dale, MD, PhD — has worked to build an effective strategy to bridge bench and bedside. In addition to using genomics data from DNA sequencing of patient tumors to identify novel biomarkers of disease and predictors of therapeutic success, they are developing cost-effective and reliable methods to screen patients at high risk for developing pancreatic cancer and working to make existing treatments, such as surgery, safer.
AT THe FOReFRONT
300
tissue samples sequenced
Researchers at the University of Chicago Medicine have sequenced the genetic code of nearly 300 banked tissue samples from 150 pancreatic cancer patients.
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WOMEN’S HEALTH Specialized and advanced treatment for women facing challenging and complex health conditions Jennifer Mason Zinga, baby Rocco and Ernst Lengyel, MD, PhD
Gynecologic oncologist Ernst Lengyel, MD, PhD, is one of only a few physicians in the U.S. who performs the radical vaginal trachelectomy (RVT) surgical procedure to preserve the fertility of a woman who has early-stage invasive cervical cancer. RVT involves the en bloc surgical removal of the cervix, the surrounding parametrium tissue and the upper two centimeters of the vagina. The uterus and lower uterine segment, left intact, are then connected to the remaining portion of the upper vagina. A permanent Mersilene cerclage is placed around the lower uterine segment to help maintain a pregnancy. About 60 percent of all women undergoing this procedure will be able to conceive; most will deliver between
RECOVERED
Reconstruction After Surgical Complications The urogynecology and reconstructive pelvic surgery team specializes in caring for women with pelvic floor disorders, including urinary incontinence; pelvic organ prolapse; rectovaginal and vesicovaginal fistulae; vaginal mesh complications; and urethral diverticulum. Patients have access to a full range of coordinated diagnostic and therapeutic services, including groundbreaking treatments and new protocols. Minimally invasive and robotic surgery are used whenever possible to optimize surgical outcomes and minimize patient discomfort.
RESTORED
Pregnancy After Cervical Cancer
Bonnie Fulgham and Sandra Valaitis, MD
32 and 36 weeks. Because of the cerclage, a cesarean section has to be performed. Criteria for trachelectomies include squamous cell carcinoma or adenocarcinoma with a less than 2-centimeter tumor. There should be no tumor evidence in the upper cervical canal and no distant metastases. The patient should not have an extensive history of infertility and should be interested in future fertility. Jennifer Mason Zinga underwent a radical vaginal trachelectomy and laparoscopic lymph node dissection after being diagnosed with squamous cell carcinoma of the cervix in spring 2012. Two years later, she delivered a healthy baby, her third son. “Our family is now complete,” Zinga said.
LEARN MORE!
8 » THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | WINTER 2015
“We offer comprehensive care for patients, including those who have complex pelvic floor disorders,” said urogynecologist Sandra Valaitis, MD, who leads the program. “Our goal is to improve the quality of life and comfort of our patients so they can live their lives to the fullest.” Bonnie Fulgham experienced several serious complications after undergoing surgery to remove uterine fibroids at another hospital. A multidisciplinary team, led by Sandra Valaitis, MD, completed a surgical repair of vesicovaginal and rectovaginal fistulae with bowel resection and ileostomy. An ileostomy takedown was successfully performed three months later. “It was very complicated, but we had seen this before,” Valaitis said. “And we knew how to fix it.”
Ernst Lengyel, MD, PhD, discusses the RVT on our online educational channel, Learning at the Forefront.
learning.uchospitals.edu
CME
Therese Byrne and Stacy Tessler Lindau, MD, MA
& EDUCATIONAL OPPORTUNITIES
12th Annual Current Concepts in Primary Care Sports Medicine ReKIndLed
Sexuality After Cancer
“The vast majority of cancers in women who survive are those that directly affect the sexual organs,” said obstetrician/ gynecologist stacy Tessler lindau, MD, Ma. “Our patients need to know they are not alone if they experience problems with sexual function. We support them during all stages of treatment and recovery.” lindau, a sexual health expert, co-directs the program with gynecologic oncologist s. Diane yamada, MD. The multidisciplinary team also includes psychologists and physical therapists and collaborates with specialists in radiology, sleep medicine, physical therapy, psychiatry, urogynecology, neurology and/or surgery as needed. This collaboration has served as a model for the development of other multidisciplinary programs across the country. After getting help at the PRISM clinic, breast cancer survivor Therese Byrne urged physicians at the 2014 American Medical Association annual meeting to address the topic of sexual health with their female patients who have had cancer. “Every woman I know who has been through breast cancer treatment has experienced some change in sexual function,” she told the audience.
Watch the AMA presentations by Therese Byrne and Stacy Tessler Lindau, MD, MA.
JUne 15 – 17
Millennium Knickerbocker Hotel 163 E. Walton Place, Chicago
Advanced Practice Nurse and Physician Assistant IBD Immersion Program
MARCH 5 – 7
MARCH 7, 8 AM – 4 PM
Millennium Knickerbocker Hotel
Westin O’Hare
163 E. Walton Place, Chicago
6100 N. River Road, Rosemont, Ill.
20th Annual Conference 2015 Radiology Review
Women and girls who have had cancer can experience sexual problems due to their illness, treatments and recovery process. The Program in integrative sexual Medicine (PRisM) is a multispecialty treatment center dedicated to helping women preserve and improve their sexual health after cancer.
21st Annual Primary Care Orthopaedics
MARCH 9 – 13
Hyatt Chicago Magnificent Mile 633 N. St. Clair St., Chicago
Endoscopy and Novel Technologies APRIL 17 – 18
University of Chicago Medicine Center for Care and Discovery 5700 S. Maryland Ave., Chicago
12th International Ultmann Chicago Lymphoma Symposium APRIL 24 – 25
Offered by the University of Chicago Medicine Inflammatory Bowel Disease Center, featuring expert gastroenterology faculty David T. Rubin, MD, and Russell D. Cohen, MD. For more details visit: www.regonline. com/ibdimmersion2015 or email ibdcenter@uchicago.edu.
University of Chicago Medicine physicians are available to present in-office CME courses in greater Chicagoland and Northwest Indiana.
For information, please contact Uchenna Hicks, uchenna.hicks@ uchospitals.edu.
Register for CME events at cme.uchicago.edu .
W Chicago City Center Hotel 172 W. Adams St., Chicago
P H yS I C I A n R e L AT I O n S Please contact your dedicated liaison by phone or email with any request. We are here to serve you. CAROL MARSHALL
deMeTRIA AvAnT
AnTHOny TURneR
Executive Director Referral and Customer Insights Marketing 1-773-702-9205 carol.marshall@ uchospitals.edu
Regional and Western Suburbs 1-773-717-0458 demetria.avant@ uchospitals.edu
South and Southwest Suburbs 1-773-729-0822 anthony.turner@ uchospitals.edu
MIKe deLAROSA
dIOnne MeeKInSMICHAUd
Northwest Indiana 1-773-230-8496 michael.delarosa@ uchospitals.edu
North and Northwest Suburbs 1-773-717-0457 dionne.michaud@ uchospitals.edu
BROOKe HeRnAndez Interim Assistant Director Pediatrics, All Regions 1-773-573-9500 brooke.hernandez@ uchospitals.edu
uchospitals.edu/prism-videos
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COMER CHILDREN’S HOSPITAL
Celebrating 10 Years! Ten years ago, the University of Chicago Medicine opened Comer Children’s Hospital, a state-of-the-art children’s medical facility on our Hyde Park campus. Today, Comer Children’s Hospital includes 172 inpatient beds, an emergency department/Level 1 pediatric trauma center, a Level III neonatal intensive care unit, a 30-bed pediatric intensive care unit and specialty outpatient clinics. With close to 170 experts in 22 pediatric subspecialties, we offer advanced diagnostics, techniques and treatments for the care of infants, children and adolescents.
Call UCM Physician Connect at 1-800-824-2282 to: » Admit a patient » Identify the appropriate specialist for a patient
» Obtain a consultation with one of our physicians
VISIT LEARNING.UCHOSPITALS.EDU Listen to our pediatric specialists discuss the latest treatments, procedures and research findings on our new online education channel, Learning at the Forefront.
2 0 1 4 QUA L IT Y & SAF ET Y SPECI AL RE P ORT
Innovations in Quality and Safety
A TOP SCORE IN SAFETY The University of Chicago Medicine received another “A” grade in hospital safety from the prestigious Leapfrog Group in fiscal 2014.
Quality and safety is an ongoing mission at the University of Chicago Medicine. Our superior rating is a measure of the care and professionalism of our entire multidisciplinary clinical staff, from physicians to nurses to pharmacists. KENNETH S. POLONSKY, MD DEAN OF THE BIOLOGICAL SCIENCES DIVISION AND EXECUTIVE VICE PRESIDENT FOR MEDICAL AFFAIRS FOR THE UNIVERSITY OF CHICAGO SHARON O’KEEFE PRESIDENT OF THE UNIVERSITY OF CHICAGO MEDICAL CENTER
We are one of about 250 U.S. hospitals to get an “A” in all six ratings surveys since the Hospital Safety Score began in 2012. Leapfrog rates hospitals across the country using 28 publicly available safety metrics,
measuring a hospital’s success in keeping patients safe from infections, injuries and medical errors. Safety is one of our fundamental missions, and our continued superior rating is a credit to the care and professionalism of our entire multidisciplinary clinical staff, from physicians to nurses and technicians. Leapfrog began in 2000 to drive improvements in safety and quality and improve transparency in health care.
Scan the QR code to download the Hospital Safety Score App and see the scores of other nearby hospitals. You can also see UChicago Medicine’s complete dataset at hospitalsafetyscore.org.
Listening to Our Patients At the University of Chicago Medicine, we are improving quality and safety by listening to our patients. New initiatives are giving patients and their families more say in their health care. For example, our nursing leadership visits regularly with patients to ask them key questions about their comfort, pain and other needs. On these regular rounds, the leader ensures that the patient’s room is free from unnecessary clutter to prevent falls. Information from these Leadership iPad Rounding Sessions is analyzed electronically in real time to confirm best practices are followed.
Data contribute to hospital-wide performance analytics and instantly identify how we can improve care for all our patients. Recently, we established an online community of more than 1,500 current and former patients. We use this virtual patient advisory board for insights on how to overcome obstacles that individuals may experience in our hospitals and with our health care professionals. We are committed to sharing back with our community how we’re using their valuable input to improve patient experiences. In the year ahead, we will be installing electronic kiosks in strategic places around the UChicago Medicine campus to gain instant feedback on the quality of care as well as the patient and family experience.
THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | QUA L I T Y & S A F E T Y S P E C I A L R E P O RT
PREDICTING AND PREVENTING CARDIAC ARREST More than 200,000 inpatients in the U.S. suffer a cardiac arrest every year: roughly 80 percent of these events prove fatal. The University of Chicago Medicine has pioneered several improvements in the effectiveness of CPR. In the multidisciplinary tradition of all our work at UChicago Medicine, physicians, nurses and researchers recently teamed up to investigate the many factors that can cause a patient to deteriorate and to identify, ahead of time, when this might occur. As part of a trial, the group used technology to collect and analyze data to see if they could predict these serious events. The data analysis showed accurate predictions, in some cases 24 hours in advance. A dedicated critical care outreach team, staffed by a group of nurse experts equipped with up-to-the-minute data and the most sophisticated tools, monitors patients to identify changes in condition that might trigger an arrest.
When the specially trained team identifies potential problems, they call in a rapid response team to intervene before the patient worsens. This has resulted in better outcomes in sepsis, faster treatment times for inpatients who suffer acute stroke and more multidisciplinary teaming in the care of acutely decompensating patients. Most significantly, during fiscal year 2014, we prevented about 26 cardiac arrests in UChicago Medicine inpatients who otherwise would have been expected to suffer this devastating complication. 70%
CPR OUTCOMES
63% 60% 50%
UCHICAGO MEDICINE
49%
NATIONAL AVERAGE
40% 30% 21% 20%
15%
0% SURVIVAL TO DISCHARGE
Dana Edelson, MD, MS, a leader in improving CPR effectiveness, with a crash cart.
The University of Chicago Medicine continued to make significant gains in a number of quality and safety measures in fiscal year 2014. Among them: » A 70 PERCENT DROP in KRVSLWDO DFTXLUHG SUHVVXUH ulcers following the adoption of HYLGHQFH EDVHG EHVW SUDFWLFHV and additional education and training. Every patient in all our hospitals is assessed daily. Our patients also receive individualized prevention plans to keep them healthy.
» A 26 PERCENT DROP in
10%
PULSE RESTORED
Quality and Safety Initiatives
FDWKHWHU DVVRFLDWHG XULQDU\ tract infections (CAUTI) after the adoption of a new protocol for evaluating catheter use. A multidisciplinary approach to process improvement led to shortened periods of catheterization that cut the risk of infection.
» Collaboration among physicians, nurses and other clinicians resulted in a decrease in the amount of time our Emergency Department was on diversion. We continue to have initiatives aimed at INCREASING THE EFFICIENCY OF DIAGNOSIS AND TREATMENT in our ED.
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NATIONAL RECOGNITION FOR
QUALITY & SAFETY (IN FISCAL YEAR 2014)
Aetna Institutes of Quality Bariatric Surgery Facility
2014 John M. Eisenberg Excellence in Mentorship Award from the Agency for Healthcare Research and Quality (AHRQ)
Advanced Comprehensive Stroke Center
Awarded to David Meltzer, MD, PhD, section chief of hospital medicine
First hospital in Chicago to earn this distinction from the Joint Commission and the American Heart Association/American Stroke Association
American Heart Association’s Mission: Lifeline Bronze Recognition For meeting treatment criteria for ST-segment elevated myocardial infarctions (STEMI)
The University of Chicago Medicine is honored to be recognized as among the best in the country for quality and safety.
The University of Chicago Medicine is in the TOP 10 in Medicare’s patient safety ranking — a combination of a number of individual patient safety measures.
PERCENT IN THE COUNTRY
Fostering Innovation The inaugural University of Chicago Medicine Innovations Grant Program supports research into more effective ways to deliver improved health care to our patients. The two winners were announced at the ninth annual Quality and Safety Symposium in May, which also featured presentations from more than 60 multidisciplinary groups.
2014 Quality Respiratory Care Recognition from the American Association for Respiratory Care Awarded to University of Chicago Medicine Respiratory Care Services
Our ongoing focus on quality, safety and patient experience resulted in our hospital ranking ABOVE STATE AND NATIONAL AVERAGES for overall patient satisfaction and how willing patients are to recommend UChicago Medicine.
Alexander Langerman, MD,
assistant professor of surgery, for a study examining ways to LANGERMAN reduce operating room costs and improve efficiencies. “The research we are conducting as part of this grant will have impact far beyond the University of Chicago Medicine as we develop better ways to treat patients and improve health care delivery,” he said.
Tina Shah, MD, MPH, a pulmonary
and critical care fellow, for a proposal centering on improved SHAH treatment models for chronic obstructive pulmonary disease (COPD) to prevent readmissions for the same condition. Shah’s is the first study of COPD readmissions from both a quality and efficiency point of view, and will fill a key gap in the medical literature.
THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | QUA L I T Y & S A F E T Y S P E C I A L R E P O RT