Network Newsletter - Winter 2010

Winter

’10

network

The Anderson Network is a program of Volunteer Services at M. D. Anderson Cancer Center

Plastic surgery enhances form and function for cancer patients

by Mary Brolley

People profiles: Mike Mason

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Survivorship issues: Coping with fear of recurrence

p. 4 Doctor, Doctor Cancer survivors and the flu

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When specialists confer

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Mention “plastic surgery,” and the response might be a smirk or a dismissive nod. Often associated with procedures to erase the signs of age, smooth the ravages of the sun or perfect body parts, plastic surgery is usually voluntary — elective — and is rarely covered by health insurance.

But Geoffrey Robb, M.D., professor and chair of the Department of Plastic Surgery at M. D. Anderson, wants you to know there’s much more to the discipline than cosmetic procedures.

In fact, reconstructive plastic surgery has emerged as an essential element of many patients’ cancer treatments, and plastic surgeons have become ever more respected members of the medical team.

Trained in microsurgery at the University of Pittsburgh School of Medicine, Robb came to M. D. Anderson in the early 1990s. He recalls that as the institution moved to a more collaborative way of working, “We plastic surgeons asked for ‘a place at the table’ to help plan treatment.”

Robb is emphatic about how crucial reconstructive plastic surgery is to many patients’ treatments. The plastic surgeon, he explains, often has to provide the tissue to protect the bone as it heals. For example, if the patient has a cancer that requires the removal of

Sharing hope, support and understanding with anyone diagnosed with cancer, regardless of where treatment is or was received.

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Plastic surgery enhances continued from page 1

his or her jawbone, the plastic surgeon might carve out a section of the fibula, a bone on the lower leg, to mold into the jaw.

Because both procedures require special care to heal, the plastic surgeon’s delicate stitching of the patient’s own vascular tissue is crucial.

Essential to cancer care Their colleagues appreciate the contributions of plastic surgeons to successful outcomes for patients.

Raphael Pollock, M.D., Ph.D., head of the Division of Surgery, notes that many multi-team surgeries in M. D. Anderson’s operating rooms involve plastic surgeons. “They remarkably extend what we can do,” he says.

Robb leads a team of 16 plastic surgeons, the largest and most productive group devoted to cancer in the world. Surgeons are natural planners and executors, he says, and input from plastic surgeons is crucial in making decisions about the timing and sequence of other surgical procedures. Also, their expertise in vascular surgery makes them sought after by oncologic surgeons who want to make sure they remove all the cancer.

“Because of plastic surgery, the oncologic surgeon can be aggressive — not concerned about the extent of the operation — to get all the cancer,” Robb says.

“Then we work to restore the body contours and maintain or restore functional elements, such as the restoration of a disfigured or abnormal body part.

And often we need to address loss of function caused by the cancer and treatment.”

Plastic surgeons are also experts in microsurgery, using a surgical microscope to aid in the careful removal and reapplication of a patient’s own vascular tissue to help restore normal contours and function.

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Innovations changing the standard of care Robb has challenged members of his team to go beyond the status quo and try to solve stubborn problems in their specialties. In response, they have made major strides in patient care.

One plastic surgeon pioneered a post-mastectomy approach that uses tissue expanders to develop and maintain natural breast contours before and after a patient undergoes radiation therapy. Others developed the integration of digital 3-D imaging to construct surgical models of the mid- and lower face that has revolutionized reconstructive strategies.

And they have changed the standard of care in the surgical management of esophageal cancer by replacing affected areas of the throat with leg tissue.

Plastic surgery offers benefits to survivors Robb says plastic surgery has much to offer cancer patients — and survivors. Some of the side effects of cancer treatment, such as neuropathy, a disorder of the nerves that causes tingling, numbness or pain, and lymphedema, abnormal swelling of a limb, may be addressed by reconstructive plastic surgery.

In fact, David Chang, M.D., professor and director of the Julie Kyte Center for Reconstructive Surgery, has developed a promising, minimally invasive procedure called lymphaticovenular bypass that essentially reroutes the built-up lymphatic fluid and eases the miseries of lymphedema.

Robb is pleased by how far plastic surgery has come at M. D. Anderson and how integrated his team is in the strategic processes of treating each patient.

“Every time we get a reconstruction case, it’s different from every other case,” he notes. “We try for an equilibrium between function and aesthetics.”

People profiles Making no excuses, defying the odds

by Laura Prus

Diagnosed with heptocellular carcinoma (a type of liver cancer) in 2004 and given four to six months to live, Mike Mason refused to accept the prognosis. He sought a second opinion, and within seven days became a patient at M. D. Anderson.

With his positive philosophy and determination in tow, Mason left his home in Coffeyville, Kan. (pop.

10,000), and traveled to Houston. His new surroundings appeared daunting, but Mason remained steadfast in his decision.

Medical team’s optimism is catching Mason received chemotherapy to shrink his tumor, and in 2006 his doctors surgically removed 40 percent of his liver. “I’m glad I didn’t accept the first opinion. Cancer is a stifling thing, but the people down there were wonderful,” Mason says of his experience at M. D. Anderson.

He was thrilled to find a helpful disposition from everyone bearing an M. D. Anderson badge, especially his medical staff. The expertise of Melanie Thomas, M.D., assistant professor in the Department of Gastrointestinal Medical Oncology, Jean-Nicolas Vauthey, M.D., professor in the Department of Surgical Oncology, and pharmacist Richard Lozano helped Mason defy his original prognosis. Together with his “no excuses” attitude, the team helped make Mason cancer free.

The optimism and support Mason received during his treatment inspired him to give back.

Searching for a way to express his gratitude, he came across information on the Anderson Network Patient and Caregiver Telephone Support Line. When he learned that the program then lacked a volunteer who’d had liver cancer, he responded, “You have one now.”

Since this enthusiastic beginning, Mason has offered hope, support and encouragement to nearly 50 patients struggling with their diagnoses. The Telephone Support Line, which matches newly

diagnosed patients with survivors of the same disease, now has three volunteers who are liver cancer survivors.

‘It’s amazing what can happen’ Because of his passion for providing hope to patients, the Anderson Network recently named Mason the 2009 Telephone Networker of the Year. He says he enjoys the opportunity to work directly with patients who are facing the same diagnosis he did.

He continues to encourage them to consult a cancer specialist.

Mason knows he is living proof that even when facing a devastating diagnosis, a chance exists. “If you search out the right places, have faith, be strong and meet with the right people, it’s amazing what can happen,” he says.

Clearly, amazing things have happened for Mason since his first doctor’s visit five years ago, leaving him very grateful to M. D. Anderson. “I’m more than willing to do anything I can to help spread the word,” he says.

For more information about the Patient and Caregiver Telephone Support Line, call 800-345-6324 or log on to www.mdanderson.org/ andersonnetwork 3

Survivorship issues Managing fears after treatment

by Laura Prus For many cancer survivors, the fear of recurrence is oppressive. It hinders them from enjoying everyday activities and profoundly affects their quality of life.

However, by learning to manage their anxieties, patients can become more confident about their survivorship.

The fear of recurrence is quite normal. Mary Hughes, advanced practice nurse in the Department

of Psychiatry, says about half the patients she meets suffer from it. “I think it has more to do with a patient’s personality. People who are worriers now really have something to worry about,” Hughes says. “The challenge is to focus on right now. The treatment is over, and you don’t have cancer.”

Patients most often feel anxiety when changes arise in their treatment. Fears run particularly high during the transition from treatment to survivorship. “No one is looking at them,” Hughes says. “They ask themselves, ‘Who’s watching me now?’”

Wading back into life Returning to a normal routine is an important step in managing the fear of recurrence. “It’s a challenge to get back to living,” Hughes says.

“Cancer is a part of your life, but it’s not controlling it.”

Hughes suggests that survivors participate in school, work, church or civic activities that distract them from their worries. Becoming a volunteer or supporting someone else in a difficult situation may also prove helpful.

“Some people may want to give back because the

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help and encouragement they had during treatment was important,” Hughes says. Of course, she also emphasizes the importance of maintaining one’s own strong support system.

Even after treatment, it is imperative that patients remain knowledgeable about their particular cancer. Patients who educate themselves on where their cancer might recur and the associated symptoms will know when they need to see a physician. This also eliminates anxieties caused by pains that are not associated with a recurrence.

Hughes says that meditation, visual imagery, yoga and tai chi are very beneficial. She recommends the programs offered at M. D. Anderson’s Place … of wellness to soothe anxieties.

‘The new normal’ sinks in Caregivers also play an integral role in eliminating survivors’ fears. “They help keep the person focused on the fact that they’ve been treated,” Hughes says.

During treatment, caregivers and patients can look to the future by setting short-term and longterm goals. Later, the caregiver can help fulfill the plans.

Dividing the household chores may help a patient return to a routine. “Maybe the caregiver took over chores and wants to give some, but not all, back,” Hughes says. “The partner can help. If the survivor cooks, the caregiver can clean up.” This allows survivors to feel more involved in everyday life.

As they ease into the next phase of their lives, it is important for survivors to remind themselves that their cancer has been treated. “They have to move out of the cancer world,” Hughes says. “Cancer was the center of their lives, but it’s not anymore.”

Doctor, Doctor Focus on the flu We asked Bruno Palma Granwehr, M.D., who is board certified in internal medicine and medical oncology, and an assistant professor in the Department of Infectious Diseases, what cancer patients and survivors should know about flu vaccines and treatments.

Should cancer patients get flu shots for both seasonal influenza and novel (2009) H1N1?

Seasonal vaccine is recommended for patients 50 and over, pregnant women, children 6 months to 18 years old, and other high-risk groups, including people with respiratory conditions (for example, asthma), metabolic diseases (for example, diabetes mellitus), those with conditions that compromise their immune systems, and those who are caretakers of high-risk patients (including health care workers and household contacts of those at risk). The 2009 H1N1 vaccine is targeted to different groups: pregnant women, those who take care of infants under 6 months old, health care workers, those between the ages of 6 months and 24 years, and people 25-64 years of age who are at higher risk for 2009 H1N1 virus infection (same high risk as seasonal influenza vaccine).

Why should patients get these vaccines?

transplant, when the likelihood of being able to mount a response is low. In those situations, it is critical for care providers to receive influenza immunization to protect patients from it. In addition, those who are allergic to eggs or have had previous allergic response to influenza immunization should not receive the vaccine.

Some

people say they develop flu-like symptoms after getting the flu shot. Why might this happen?

The flu shot (or “inactivated” vaccine) cannot result in influenza infection, but the response to the influenza shot may result in some generalized symptoms, including fever and muscle pain. Since the vaccine is provided during respiratory viral season, some people may have another respiratory viral infection at the time of their immunization.

Typically, when I ask those who “had the worst flu of their lives” after receiving the vaccine, none of them have had influenza confirmed in a health care provider’s office.

Are there any other considerations for cancer patients?

Many cancer patients are at high risk for severe influenza virus infections and are as likely as the general population to respond to the vaccine.

If available, patients can receive seasonal and 2009 H1N1 vaccine at the same time. Timing of vaccination may be important if the patient is receiving chemotherapy or undergoing stem cell transplant. They should talk with their physicians.

The seasonal vaccine protects against different strains of influenza virus than the 2009 H1N1 vaccine. Since the 2009 H1N1 virus is the predominant circulating virus in the United States, current patients and cancer survivors should receive both vaccines if they are in appropriate categories.

Are there situations where it might be unsafe or unwise to get one?

There may be little benefit to those who are receiving active chemotherapy or stem cell

If a cancer patient develops the flu, is it safe for him or her to take Tamiflu®?

Tamiflu is generally safe for cancer patients, other than those with a prior allergic response to Tamiflu (oseltamivir) or Relenza® (zanamivir).

Nausea and vomiting have been reported, and Tamiflu is considered a pregnancy Class C drug, so it should be used with caution in this population. As with any medication, risks and benefits should be weighed before treatment.

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Research When specialists confer, patients benefit

by Mary Brolley It all started with feedback.

For several years, Deborah Kuban, M.D., asked men who’d been treated for prostate cancer at M. D. Anderson how they felt about it.

“A common theme emerged,” says Kuban, professor in the Department of Radiation Oncology and medical director of the Multidisciplinary Prostate Cancer Clinic. “Patients said they’d expected more.”

“Rather than seeing two physicians — a urologist and a radiation oncologist, for example — separately, they’d hoped to see them together and have them confer with each other, then make a recommendation.”

“A number of patients said, ‘I expected you to do more to help me put it all together.’”

From this plea for collaboration and transparency has grown a remarkable multidisciplinary clinic for men diagnosed with prostate cancer. Five years in existence, the Multidisciplinary Prostate Cancer Clinic attracts an ever-growing number of patients eager to have a team of experts take an unbiased look at their cases.

Prostate cancer will strike one in six men in the United States in their lifetimes. More than 190,000 were diagnosed with the disease in 2009.

With medical advances, survival rates are impressive. Five-year survival is close to 100 percent and 15-year survival is 76 percent, yet prostate cancer is still the second leading cause of cancer death in men.

For the two million men living with the disease in the United States, the treatment choices they make during a stressful time may have an impact on the rest of their lives. The clinic tries to give patients as much information as possible in a coordinated way so that they are able to make the best choice.

Steering through a thicket of choices For early prostate cancer, patients have several choices for treatment, with similar cancerfree outcomes and survival, Kuban says. These treatments include open and robotic surgery,

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external beam radiation, and radioisotopic implant. There is “watchful waiting,” also called active surveillance, and newer treatments under study such as high-intensity focused ultrasound and cryotherapy, or freezing.

Each treatment has different short- and longterm side effects and complications that will likely affect a patient’s quality of life.

“We give them our honest opinion. I tell patients, ‘We’re on staff; we get paid the same no matter what you choose,’” Kuban says. “‘We just want the best care for you.’”

M. D. Anderson’s large patient population gives newly diagnosed men an advantage: The experts helping them choose a treatment have seen many patients with the same type and extent of disease.

What do patients want?

A 2006 survey of clinic patients completed a few years after the multidisciplinary clinic opened yielded valuable information about what they considered important. They asked for a useful Internet site to get them started and to refer to when they had questions, a “visit map” and a “treatment map” to outline their visit step by step and provide details about their options. They also wanted the opportunity to follow up with their care team.

In response, members of the clinic staff also developed a teaching packet that contains a standard set of information for all patients and lays out the options.

When they visit the clinic, patients see an advanced practice nurse, a resident or a fellow and two physicians. Once they have reviewed each patient’s case, the physicians confer, then decide on a joint recommendation for treatment.

Before they leave the clinic, patients receive an individual letter detailing the physicians’ consultation and recommendations.

“Sometimes there is not one best treatment,” Kuban says. “We rule out those that won’t work and give them a list of best options.”

The advanced practice nurse in the clinic, Lydia Madsen, is the first — and last — staff member patients see.

Madsen has been with the clinic since 2006. She helps patients navigate the complicated process.

“They get all this information, but what do they do with it? I let them know they can ask me anything, all through the process. I encourage them to take it all home and think about it, and call me later.”

The clinic is another step toward personalized cancer care, Kuban says. “We take the patient’s cancer into account, of course, but also other medical problems he may have, as well as his lifestyle, to direct him to the best treatment or treatments.”

Multidisciplinary model enhances understanding Working closely with her colleagues in urology and medical oncology has enriched Kuban’s experience and practice, she says. “It’s helped me understand what they deal with. You’re face-to-face.

You get to know each other, and it’s helped improve relationships.”

There’s growing national interest in this multidisciplinary model in academic medical centers, she says.

And patient satisfaction statistics show that the clinic has helped “close the loop” for patients, and that they are extremely positive about the experience.

This doesn’t surprise Kuban, who’s always been tuned in to her patients.

“If you listen to them, you get a lot of good information,” she says.

Another gratifying measure might be the very high rate at which the clinic’s patients decide to participate in clinical research trials.

Nearly 80 percent, Kuban says.

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The University of Texas M. D. Anderson Cancer Center Division of Public Affairs 156300/18050663 – Unit 700 6900 Fannin St. FHB 5th Floor, Room 5.1082 Houston, TX 77030-3800

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network The Anderson Network is a program of Volunteer Services at M. D. Anderson Cancer Center.

Address changes should be sent to: Mary Brolley The University of Texas M. D. Anderson Cancer Center Communications Office – Unit 700 6900 Fannin St. Houston, TX 77030-3800 Phone: 713-792-0658 Fax: 713-563-9735 E-mail: mbrolley@mdanderson.org Articles and photos may be reprinted with permission.

Susan French, Executive Director, Volunteer Services Debbie Schultz, Assistant Director, Volunteer Services/ Anderson Network Mary Brolley, Writer/Editor, Network Laura Prus, Contributing Writer Gini Reed, Graphic Design Pamela Lewis, Chair, Anderson Network © 2010 The University of Texas M. D. Anderson Cancer Center

Page 8 Briefs Survivorship information online • M. D. Anderson’s Internet site with pertinent information on survivorship: www.mdanderson.org/topics/survivorship • Three services provided for patients/survivors and caregivers by Anderson Network, a patient and caregiver support organization in the Department of Volunteer Services: ° The Cancer Survivor Message Board, offering a place to ask questions, talk or just listen: www.mdanderson.org/andersonnetwork ° WarmNet, an online subscription listserv for cancer patients/survivors, caregivers, family members and friends: www.mdanderson.org/andersonnetwork ° Ask the Expert, an online forum featuring timely cancer topics and the chance to have your questions answered by M. D. Anderson cancer experts: www.mdanderson.org/asktheexpert

Network’s new editor, Mary Brolley, is a longtime writer for newspapers and magazines in Louisiana and Texas. She joined M. D. Anderson in 2008.

Save the date: Cancer Survivorship Conference — An annual conference presented by the Anderson Network, Department of Volunteer Services, M. D. Anderson Cancer Center

Sept. 24-25, 2010