MD-UPDATE Issue #95

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #95

A TRANSFORMATIVE MOMENT IN CANCER CARE

The James Graham Brown Cancer Center expands its expertise to northeast Louisville, advancing access and cancer therapies regionally and globally

SPECIAL SECTIONS

VOLUME 6•#6•NOVEMBER 2015

ONCOLOGY & RADIOLOGY

ALSO IN THIS ISSUE  Q&A WITH NEW KMA PRESIDENT  ADVANCES IN RADIATION THERAPY  A CANCER RESEARCH PARTNERSHIP

 TARGETED THERAPIES MORE EFFECTIVE, LESS DAMAGING  ONCOPLASTIC BREAST SURGERY AND BIOZORB™  3D MAMMOGRAPHY ENHANCES DETECTION

More locations for digital mammography screenings.

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Screening mammograms are fast. They’re safe. And early detection is your best protection. For peace of mind, schedule an appointment at one of our convenient locations listed below.

LOUISVILLE AREA Jewish Hospital 200 Abraham Flexner Way Louisville, KY 40202 502.587.4327 Sts. Mary & Elizabeth Hospital 1850 Bluegrass Avenue Louisville, KY 40215 502.587.4327 James Graham Brown Cancer Center 529 S. Jackson Street Louisville, KY 40202 502.587.4327 3D Mammography available Flaget Memorial Hospital 4305 New Shepherdsville Road Bardstown, KY 40004 502.587.4327 Jewish Hospital Shelbyville 727 Hospital Drive Shelbyville, KY 40065 502.587.4327

Medical Center Jewish East 3920 Dutchmans Lane Louisville, KY 40207 · 502.587.4327 3D Mammography available

Partners in Women’s Health 3940 Dupont Circle Louisville, KY 40207 502.587.4327

Medical Center Jewish South 1903 W Hebron Lane Shepherdsville, KY 40165 502.587.4327

Total Woman 4121 Dutchmans Lane, Suite 500 Louisville, KY 40207 502.587.4327

Medical Center Jewish Southwest 9700 Stonestreet Road Louisville, KY 40272 502.587.4327

LEXINGTON AREA

James Graham Brown Cancer Center Mobile Mammography Van 502.587.4327 Louisville OB/GYN 3999 Dutchmans Lane, Suite 4D Louisville, KY 40207 502.587.4327 Louisville Physicians for Women 4121 Dutchmans Lane, Suite 101 Louisville, KY 40207 502.587.4327

KentuckyOne Health Office Park (formerly Saint Joseph Office Park) 1401 Harrodsburg Road, Suite C-45 Lexington · 859.967.5613 KentuckyOne Health Imaging – Tates Creek 1099 Duval Street, Suite 150 Lexington · 859.313.3554 3D Mammography available Saint Joseph Berea Merle M. Davis Digital Mammography Suite 305 Estill Street, Berea 859.986.6587

Saint Joseph East Medical Office Building 160 N. Eagle Creek Drive, Suite 101 Lexington · 859.967.5613 3D Mammography available Saint Joseph Jessamine Sandra J. Adams Digital Mammography Suite 1250 Keene Road, Nicholasville 859.967.5613 Saint Joseph London 1001 Saint Joseph Lane, London 606.330.6060 Saint Joseph Martin 11203 Main Street, Martin 606.285.6480 Saint Joseph Mount Sterling 225 Falcon Drive 859.497.5000

You’re Invited!

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Please join us!

Saturday, November 7, 2015 Lexington Convention Center Cocktails | 6:30-7:30 p.m.

Silent Auction | 6:30-9:30 p.m.

Dinner | 7:30 p.m.

Performance by Mercy Men following honoree recognition Reservations are limited!

Proceeds benefit the Saint Joseph Hospital Foundation’s mission and outreach programs that build healthier communities.

To Reserve Tickets or For More Information Contact April Nease Saint Joseph Hospital Foundation P 859.313.1705 | E amnease@sjhlex.org KentuckyOneHealth.org ISSUE#95 1

CONTENTS

ISSUE #95

COVER STORY University of Louisville Physicians from the James Graham Brown Cancer Center who practice at Medical Center

3 PUBLISHER’S LETTER 4 HEADLINES 5 FINANCE

Jewish Northeast, jointly operated by KentuckyOne Health and U of L. Pictured left to right: Donald Miller, MD, PhD,

6 LEGAL 8 Q&A 9 PHYSICIAN VIEWPOINT

Beth Riley, MD, FACP, Vivek Sharma, MD, FACP, Mounika Mandadi, MD, Adam Rojan, MD, and

10 COVER STORY 16 SPECIAL SECTION: ONCOLOGY

Jorge Rios, MD.

A TRANSFORMATIVE MOMENT IN CANCER CARE The James Graham Brown Cancer Center expands its expertise to northeast Louisville, advancing access and cancer therapies regionally and globally. BY JENNIFER S. NEWTON, PAGE 10

22 SPECIAL SECTION: RADIOLOGY 26 COMPLEMENTARY CARE 28 NEWS 30 EVENTS

PHOTOS BY ROBERT BURGE AND BRIAN BOHANNON

SPECIAL SECTIONS ONCOLOGY

16 INCREASING PRECISION, DECREASING TREATMENT TIMES: BAPTIST HEALTH

2 MD-UPDATE

RADIOLOGY

17 BUILDING BRIDGES TO CANCER CARE: NORTON HEALTHCARE

COVER PHOTOGRAPH BY ROBERT BURGE

19 KILLING IT SOFTLY: KENTUCKYONE HEALTH

21 PRESERVATION AND PRECISION: OWENSBORO HEALTH

22 A NEW DIMENSION: FLOYD MEMORIAL

24 MAMMOGRAPHY IS NOT BLACK AND WHITE: KENTUCKYONE HEALTH

LETTER FROM THE PUBLISHER

MD-UPDATE MD-Update.com Volume 6, Number 6 ISSUE #95 PUBLISHER

Gil Dunn gdunn@md-update.com EDITOR IN CHIEF

Jennifer S. Newton jnewton@md-update.com GRAPHIC DESIGNER

James Shambhu art@md-update.com

CONTRIBUTORS:

Jan Anderson, PsyD, LPCC Andrew DeSimone Jonathan Feddock, MD Scott Neal

CONTACT US:

ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:

Gil Dunn gdunn@md-update.com

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38 Mentelle Park Lexington KY 40502 (859) 309-0720 phone and fax Standard class mail paid in Lebanon Junction, Ky. Postmaster: Please send notices on Form 3579 to 38 Mentelle Park Lexington KY 40502 M.D. Update is peer reviewed for accuracy.

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Individual copies of M.D. Update are available for $9.95.

Meeting the Challenge of Cancer The MD-UPDATE oncology issue is always challenging because there are so many stories to tell about Kentucky physicians and their work in prevention and treatment of cancer. In Kentucky there’s on-going research and innovative treatment in medical oncology and radiation; advancements in diagnosis through enhanced radiology; and there’s new post-operative treatment.

We’ve included articles on these (l-r) Patrick Williams, MD, medical director topics along with the physicians at Norton Cancer Institute, with Gil Dunn, who are practicing their art. publisher of MD-UPDATE at the Colors of There’s also fundraising to Courage event for Hope Scarves. support many of the same medical efforts coupled with patientcentered care. MD-UPDATE brings you closer to two individuals, Lara MacGregor of Hope Scarves and Dr. Jonathan Feddock, UK radiation oncologist and founder of Ironcology, who are committed to their causes of connecting others to cancer care.

Nothing shows the depth and breadth of the kind and compassionate human spirit like giving to others.

One comment I heard during our interviews really stuck with me. “We don’t cure cancer, we treat it,” said the doctor. “My patients don’t just survive cancer, they live with it or without it, often very normally and productively.”

Participation

In upcoming issues of MD-UPDATE we’re talking about state-of-the-art neurosurgery in Kentucky, pain medicine, ENT, mental health, internal medicine, geriatrics, and ophthalmology. If you’re practicing one of those specialties, I invite you to contact us and tell us what you’re doing and how are you doing it. Your colleagues will appreciate you for taking that initiative.

Until next time, all the best,

Gil Dunn Publisher, MD-Update

Send your letters to the editor to: jnewton@md-update.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax ISSUE#95 3

HEADLINES

Like Being the Pope for Doctors

problem that brings to the healthcare industry.

To help cope with this patient population, Stack encouraged physicians to refer patients to proven diabetes prevention programs, such as at the YMCA, that have a 72 percent success rate for individuals over 60 years old. The AMA has partnered with the YMCA to make these programs affordable and available to all, he said.

Revising medical education is the second of the AMA’s initiatives. “Medical education needs to modernize to adapt to the new complexities of practicing medicine,” said Stack, LEXINGTON Speaking to the Lexington Medical “including teaching finance and how to deal Society (LMS) on September 8, 2015, AMA with hospital and healthcare systems adminisPresident Steven J. Stack, MD, listed three initia- tration and insurance companies.” As healthtives as goals for his term in the care insurance companies position he described as being consolidate, hospitals con“like the Pope for doctors.” solidate to form a “monWell aware of the challengopsony power that dictates es and frustrations that docwhat and how physicians tors face every day, Stack said, are paid for their services,” “My opportunity is to paint a said Stack. brighter future for physicians Monopsony, Stack of today and the physicians of explained, is a market contomorrow.” dition where one buyer sets To do that, Stack pointed the price for services. It is “To have a healthier nation, to physician satisfaction and similar to monopoly power we need a healthy physician sustainability in the workplace workforce,” says AMA President where one supplier sets the as his first priority. “To have Dr. Steven J. Stack. price. a healthier nation, we need a Stack’s third initiative is healthy physician workforce,” he said. “Who to continue to make the AMA relevant to phyin this room isn’t frustrated by EMR and with sicians and for them to have a positive opinion a staff similarly frustrated by it?” he asked. To of what the AMA stands for. The 125,000+ air address physician burn-out he cited an upcom- miles that he expects to travel this year testify to ing physician wellness program presented by his commitment to meet and engage physicians the LMS that begins in January 2016 with free on every level. “Leading like a general, from counseling sessions for all active members. the top down, is old school and doesn’t work Stack also cited the 86 million Americans anymore,” he said. “I try to lead from within.” who are pre-diabetic, roughly one third of the Contact Dr. Steven Stack at: stevenstack@ total adult US population, and the enormous ama-assn.org. ◆

AMA president speaks at Lexington Medical Society September Meeting

Dr. Andrew Moore, II, receives award from Aaron Stevens, professional wrestler from Louisville.

Surgery on Sunday Founder Receives Muhammad Ali Humanitarian Award

The 2015 Muhammad Ali Kentucky Humanitarian Award was presented to Dr. Andrew Moore, II, at the Muhammad Ali Humanitarian Awards, Saturday, Sept. 19, 2015 at the Marriott Hotel in Louisville.

Moore was the founder in 2005 of Surgery on Sunday, an all volunteer organization which provides, at no cost to the patient, essential outpatient surgical services to individuals who are underinsured or uninsured. Since its beginning, Surgery on Sunday has provided over 5,600 surgeries.

LOUISVILLE

2335 Sterlington Road, Suite 100 Lexington, Kentucky 40517 (859) 268-1040 Fax: (859) 268-6165 Email: lprober ts@barcpa.com www.barcpa.com

4 MD-UPDATE

LEFT PHOTO BY GIL DUNN, RIGHT PHOTO BY BRIAN BOHANNON

FINANCE

Financial Miscellany In keeping with the news and the season, there are several topics to discuss this month. Here a just a few.

NEGATIVE INTEREST RATES. The focus of media has been on the Federal Reserve decision to hold interest rates near zero.

As investment advisors, our focus is on the open market as investors bid down the rate by bidding up the price of bonds.

Many investors typically have a hard time even thinking about negative interest rates, much less actually paying the bank to hold their funds. Yet negative interest rates have become fairly common in some European and Scandinavian countries.

We recently asked our friend Ed Easterling, author of Unexpected Returns and Probable Outcomes, to comment. Ed responded, “In my work, I state that interest rates are compensation for financial inflation. In periods when the inflation rate is near zero or negative (deflation), interest rates, in theory, should not decline below zero—investors have the tradeoff of holding cash at zero return.” He goes on, “Yet that tradeoff requires that investors hold currency. For some investors – especially very large ones—it is costly and impractical to hold such large sums in currency. That would require transportation, storage, security, etc. As a result the most efficient tradeoff is to bid securities to a level that drives the effective return into negative interest rates. The negative interest rate is a fee for service to hold and protect the funds.” The prospect of deflation in our own economy raises the question of whether we may be faced with a similar circumstance in the not-too-distant future.

MACROECONOMICS. Pundits and selfstyled experts are quick to point out the causes for the recent market declines.

Popular reasons include: 1) China’s issues, both financial and economic; 2) the realization that the EU is an experiment looking for a scientist; 3) our own Fed playing kickthe-can; and 4) the implosion of emerging markets and their failure to fuel worldwide growth. We have written before about our belief that the fundamental cause of decline is the low rate of growth in global GDP. The key statistic for 2014 might have been that

there were more closures than startups of small businesses. I am sure that I don’t need to tell our readers about the adverse effects of over-regulation on an industry.

The upcoming

BY Scott Neal election cycle will provide us an opportunity to listen for the possibility of structural reform and redesign of our incentive structures. Rather than simply focusing on cyclical recovery, as has been the focus of policymakers, we need a refocus on what will restore growth. This is especially important now that we live in a world of very low commodity prices. With proper incentives our growth rate could likely be twice the current reading. Low growth portends tough sledding ahead.

VOLATILITY OF STOCKS. If you have been in hiding since August, you might need a reminder that volatility is back. The third quarter of 2015 was the worst quarter since Q3 of 2011 and the first week of October was the best week for stocks all year. Stocks were still down for the year as of this writing in mid-October. As volatility increases late in a bull cycle, the probabilities of nearing a top in the cycle begins to mount. This leads us to other technical indicators, such as market breadth and sentiment, for confirmation. We measure the breadth of the market by looking at the advance decline line of the New York Stock Exchange.

The 50 day moving average of the A-D line recently crossed down over the 200 day moving average for the first time since 2008. While this is not conclusive, it is certainly worth keeping a watchful eye.

Increased volatility also gives an opportunity to make money by trading. Ed Easterling once again: “Most investors, especially those with traditional stock and bond portfolios, profit when the market rises, and lose money when the market declines. . . They are, in effect, simple sailors in market waters, getting blown wherever the market wind takes them.” Rowing, on

the other hand, is analogous to an absolute return approach to investing that attempts to make money in both up and down markets. This is accomplished by trading (trying to buy low and sell high) rather than the traditional approach of buy-holdand-rebalance. The increase in volatility is a signal that it may be time to move from sailing to rowing, especially if your time frame is relatively short. One can either fear volatility or embrace it.

TAX PLANNING. The filing of last year’s tax returns should all be complete by now since the extended due date was October 15th. Time is quickly running out on tax planning opportunities for 2015. At this point for our planning clients, today we generally make it a practice to project 2015 and 2016 tax consequences with the known data and assumptions. Already we have modeled tax scenarios such as taking capital gains (or losses), making charitable contributions, or even getting married before year end. There are several things to consider: Investments in fixed assets can reduce taxable income for many physicians by claiming Sec 179 depreciation. Contributions to retirement plans can usually be postponed until the filing of the return, but many new plans need to be established by filing of paperwork prior to year-end to be effective for this year. If you pay estimated taxes it is usually, but not always, a good idea to pay the state taxes before the year end.

Bunching deductions in one year for such things as discretionary medical procedures is often a good idea. If required to do so, be sure that you have taken your required minimum distribution (RMD) from your retirement plans before December 31st. The penalty for not taking the RMD is steep. Be sure to review the provisions of the tax code that are due to expire this year and keep up to date on any late extensions passed by Congress. If you would like a tax planning checklist, simply drop us a note.

Scott Neal, is President of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. Write him at scott@dsneal.com or call 800-344-9098. ◆ ISSUE#95 5

LEGAL

Kentucky’s Informed Consent Law A new opinion by the Kentucky Supreme Court has altered the application of informed consent in medical malpractice lawsuits in Kentucky. This opinion will likely impact your approach to discussing the risks and benefits of medical procedures performed on your patients. Prior to August 2015, the Kentucky Supreme Court gauged an informed consent lawsuit based upon what a reasonable physician would do under the same or similar circumstances. This is the same standard for a medical malpractice lawsuit in general: Did the treatment provided by the physician meet the standard of care of what a reasonable physician would do under the same or similar circumstances?

The Supreme Court’s latest opinion, in a medical malpractice lawsuit Sargent v. Shaffer, 2013‑SC‑111, highlights that physicians must conduct the informed consent dialogue from the perspective of the patient. Failing to do so may open the door for a lawsuit based upon an alleged lack of informed consent.

Kentucky’s Informed Consent Law is found in the Kentucky Revised Statutes, in particular KRS 304.40‑320. This statute provides the parameters of an informed consent lawsuit against physicians. This

bers of the profession with the similar training and experience.”

Moreover, the informed consent must provide to “a reasonable individual” (1) “a general understanding of the

BY Andrew DeSimone procedure”; (2) medically accepted alternative treatments; and (3) the “substantial risks” of the procedure as “recognized among other healthcare providers.” The Kentucky General Assembly has carved an exception for emergency situations, “where the consent of the patient cannot reasonably be obtained.”

The Sargent v. Shaffer case involved a lumbar laminectomy and decompression, which required removal of bone and scar tissue. Shortly after surgery, the patient experienced weakness in her lower extremities, and she eventually ended up paralyzed below the waist and incontinent. The patient sued, alleging, among other things, that she had not been informed that paralysis and incontinence were potential risks

or “loss of bowel and bladder control” when discussing the risks of the procedure. At trial, the surgeon’s position, and the position of the surgeon’s experts, was that the phrase “nerve damage” encompassed all of these risks. At trial, the jury found in favor of the surgeon.

The Kentucky Supreme Court reversed the jury’s verdict on the informed consent claim because the jury was only instructed that the informed consent must be provided based upon what a reasonable physician would do under the same or similar circumstances. However, the Supreme Court held that proper jury instructions must be based on KRS 304.40-320, and include the informed consent discussion from the perspective of the patient; that is, would “a reasonable individual,” following the discussion with his or her physician, have an understanding of (1) the procedure; (2) the medically accepted alternative treatments; and (3) the “substantial risks” of the procedure as “recognized among other healthcare providers.” In reaching its decision the Supreme Court went on to say the main question to be asked of the jury in the Sargent case was “whether a ‘reasonable individual’ would generally understand that ‘nerve injury’ included the possibility of permanent paralysis below the waist.”

So what does this case mean in a practical sense for the physician having an informed consent dialogue with his or her patient? First, continue the practice of fully explaining the risks and benefits of the procedure with your patients using clear, understandable language. Second, physicians obtaining informed consent must (1) consider whether the information shared with the patient will be understood by a reasonable person (someone not medically trained); and (2) write on the informed consent document almost every reasonable adverse outcome related to the proposed procedure. As an example of what a lay person would understand, consider a gastrojejunostomy where

The Supreme Court’s latest opinion in medical malpractice highlights that physicians must conduct the informed consent dialogue from the perspective of the patient.

type of lawsuit often alleges that the physician was negligent in informing the patient of the risks of the procedure, and if the patient had known all of the risks, he or she would not have agreed (or consented) to the procedure.

In particular, KRS 304.40-320 states informed consent for a procedure “shall be deemed to have been given” when the physician provides the consent according to “the accepted standard . . . among mem6 MD-UPDATE

to the procedure. According to the written informed consent document, the patient was warned of the risks of “infection, bleeding, nerve damage, dural leak, injury to the nerve, and destabilization of the scoliosis requiring fusion.” The patient was also warned of the risk of injury to adjacent structures along with the risks associated with anesthesia.

The surgeon admitted that he never used the words “paralysis,” “incontinence,”

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the physician warns of “bleeding, infection, and damage to adjacent structures.” Does this informed consent discussion warn a reasonable, non-medically trained person of the risk that the anastomosis may break down leading to sepsis and potential death?

To a reasonable lay person: arguably, no.

Instead, it is better practice to list “breakdown of anastomosis” in addition to “infection.”

Therefore, the written informed consent document should be as clear and explicit as possible in warning of the potential risks and in discussing possible alternatives to the proposed procedure. To avoid the possibility of confusion afterwards, the better practice will be to list out each potential risk, and each possible alternative. This may take more time initially, but it will be better documentation in case of litigation. This will

require your practice group to change its consent forms to incorporate the suggested changes to its current format. While Sargent has altered the legal construct surrounding informed consent, the physician should continue to use best practices in obtaining the informed consent: communicate the risks and alternatives in clear language, with an opportunity for the patient to ask questions before the administration of anesthesia; and, of course, document, document, document.

Andrew D. DeSimone is a partner with Sturgill, Turner, Barker & Moloney, PLLC. DeSimone concentrates his practice in the areas of healthcare law and medical malpractice defense. He can be reached at adesimone@ sturgillturner.com or (859) 255-8581.

This article is intended as a summary of state law and does not constitute legal advice. ◆

Issue #96 November – IT’S ALL IN YOUR HEAD, Neurology, ENT, Pain Medicine / Mental Health, Smoking Cessation Issue #97 December/January 2016 PREVENTION AND SENIOR HEALTH, Internal Medicine (including Hospitalists and Concierge Medicine), Family Medicine & Geriatrics, Ophthalmology / Physician Extenders, Residential Care *EDITORIAL TOPICS ARE SUBJECT TO CHANGE.

TO PARTICIPATE CONTACT: Gil Dunn, Publisher • gdunn@md-update.com/ (859) 309-0720 Jennifer S. Newton, Editor-in-Chief • jnewton@ md-update.com/(502) 541-2666

Helping Kentuckians Live Healthier Lives Ask your colleagues about their experience with Passport and call us to learn more about joining our network.

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2/23/15 8:45 AM ISSUE#95 7

Q&A

Q&A with 2015 KMA President

MD-UPDATE EDITOR-IN-CHIEF JENNIFER NEWTON SPOKE WITH INCOMING KENTUCKY MEDICAL ASSOCIATION (KMA) PRESIDENT THEODORE H. MILLER, MD, PHD, AN ENT PHYSICIAN WITH ENT & ALLERGY SPECIALISTS IN NORTHERN KENTUCKY, TO DISCUSS THE KMA’S ANNUAL MEETING AND THE PRIORITIES FOR HIS TERM. MD-UPDATE: Tell us about yourself and your professional background.

MILLER: I had a circuitous background before I came into medicine. I went to graduate school and got a masters and PhD in experimental psychology. I did research and then went into the Navy during the Vietnam War. I actually got drafted, got postponement of induction, and found the Navy would let me finish my degree and do research on active duty. I did research in hearing at the Submarine Medical Research Laboratory in Groton, Connecticut. While I was in there, I had an interest in medicine from my graduate school days, and I did a lot of reading in ear, nose, and throat literature. When I left the Navy I had been accepted at U of L School of Medicine.

I graduated in 1980. Then I choose ENT and did my residency at the University of Cincinnati. I’m basically from the Cincinnati area. I went into private practice here, eventually limiting my practice to Northern Kentucky. I was practicing solo up until 2006 when it got to be too costly with various EMR requirements, so I joined a 10-physician ENT group. I got interested in organized medicine, and my first position was as a delegate from Northern Kentucky to the KMA meeting.

What was the focus of the KMA Annual Meeting this year?

We had an initiative a couple of years ago when Fred Williams, MD, was president to try to update the KMA and to make it more in tune with the way young doctors practice today. A focus group of physicians looked at the structure and function of the organization and did surveys of the membership to see what services were important to them. As a result of that, the format of the annual meeting was changed, in an attempt to make it more efficient and accessible to more physicians. The focus of the meeting this year was physician leader8 MD-UPDATE

ship. Fred had inaugurated the Community Connector program to recognize physicians active in charitable, non-profit work in their communities. We had nine Community Connectors this year, and I was one of those. As part of that program, a Leadership Academy was rolled into the annual meeting and was open to anyone.

Right now we are blessed in Kentucky to have the current American Medical Association (AMA) president from Lexington [see related story on pg. 4], and Ardis Hoven from Lexington, who was president two terms ago.

We also have Bruce Scott, MD, from Louisville, who was just elected as the vice-speaker of the House for the AMA, and Greg Cooper, MD, from Cynthiana, who was elected as chairman of the southeast delegation to the AMA. Right now Kentucky is represented in leadership positions in organized medicine nationally.

What are your priorities for this term?

We’re still working on integrating the goals of the Focus Forward committee.

One of our main goals, as expressed by the membership as one of the most important functions the KMA serves, is political advocacy. We’re very active in that through our Legislative Action Commission. Part of the reorganization of the KMA was to change from a committee-based to a commissionbased structure.

What are the KMA’s legislative priorities this year?

One is Smoke-Free Kentucky legislation. We also have an interest in the heroin epidemic that’s hitting this state, particularly in Northern Kentucky. On the backburner, but always a priority, is to get some sort of tort reform. We’ve come close in the past.

Although it’s not a legislative priority, one of the issues that’s very important to us as an organization is addressing our membership numbers. Young physicians often

don’t think they need organized medicine as much as doctors have in the past. Given the complexity of medical practice these days, I think they need us more than ever. The more they learn what organized medicine does for them, and experience the passion we have for it, the more they will be attracted to membership.

Anything new with the Smoke-Free Kentucky initiative?

The KMA continues to support SmokeFree Kentucky legislation. I’m also on the board of the Kentucky Foundation for Medical Care, which is looking at new ways to address that problem through public education programs. I think that’s a big step. If you get people aware of the problem, they’re going to be more receptive to modifications of behavior and new legislation.

What other Focus Forward priorities will you be working on?

One of the things the Focus Forward committee brought out was the need for new communication techniques, and so we’ve hired a communications director.

We’re trying to modify the way we reach members and non-members. We’ve changed some of our publications. We’re trying to get more involved in social media. One of the highlights of our Leadership Academy at the annual meeting was having Kevin Pho, a national social media guru, speak to us. ◆

Join Now Visit www.kyma.org Click on Membership Tab Click on Join/Renew Email member@kyma.org Call 502-426-6200

PHYSICIAN VIEWPOINT

Ironcology Update

BY JONATHAN FEDDOCK, MD EDITOR’S NOTE: Ironcology is the name created by Dr. Jonathan Feddock, radiation oncologist at UK HealthCare and the Markey Cancer Center. Feddock created “Ironcology” in 2014 to raise awareness and funds for a new brachytherapy suite at UK. Feddock and Ironcology were first profiled by MD-Update in Issue #84, October 2014.

This has honestly been a very busy year. When I originally created Ironcology, it was simply an idea of racing in Ironman Louisville with a goal of raising $200,000 to guarantee some much needed equipment upgrades at the cancer center. After I was able to raise $54,000 in this first race, I felt responsible for maintaining the momentum. By the end of the 2014 calendar year, I had raced a total of four Ironman competitions while maintaining a blog, and I had raised $141,000.

The most rewarding aspect for me since starting my Ironcology campaign has been the community support and feedback. In addition to the tremendous influx of donations made by friends, family members, patients, and others from the community, I have also made many new friends and collaborators this past year who tell me they are inspired and wish to help with my cause. I have formed my own “Ironcology Team,” initially comprised of only four people, but growing. Ironcology is now a recognized fundraising organization. We have a new website, Ironcology.org, and in addition to blogging and using long distance triathlons to fundraise, we have even branched into holding our own event.

In June, my small Ironcology team pulled off the first ever overnight Ironman-distance triathlon relay that we called “Survive the Night.” This was an overnight team relay where teams completed a full distance triathlon, 140.7 miles, but could divide the distances up between 10 team members.

The race was held between Spindletop Hall and the Kentucky Horse Park. We had 27 teams complete the distance, and this was LEXINGTON

combined with an exercise event with our vision titled “The Healthiest Weekend in Lexington.” The goal was to raise cancer awareness while promoting a healthy lifestyle, and netted $27,000.

The current total that I have raised through Ironcology is $174,511. Although I am still short of my original goal, I anticipate we will have surpassed $200,000 before the middle of October 2015. I will be racing Ironman Louisville again on October 11, and I have been very fortunate to have earned a few local sponsorships with Big Ass Solutions, Audi of

Lexington, SWORD performance drink, and CGS automation, who have each been trying to help me reach my goal.

UK HealthCare has similarly been very supportive as my brachytherapy suite has already been approved for the remaining funds, and we are currently in the design process, with an anticipated completion by the end of spring 2016.

The big picture for Ironcology is that it’s here to stay, at least for now. Once I reach my goal for the brachytherapy suite, I am simply going to shift my focus to begin fundraising for whatever is needed at the cancer center. My next fundraising goal will

Dr. Jonathan Feddock and wife Shannon Florea at a recent race.

One of the teams competing in the “Survive the Night" Triathlon was KFC- Kids Fighting Cancer.

be to support some of the innovative clinical trials written by UK physicians who are need of grant support. Very soon I will have to begin planning for next year’s Survive the Night triathlon, but this time I will be joining forces with the Lexington Cancer Foundation to add their Roll for the Cure bike event, so we can truly create a much larger event combining a healthy lifestyle and cancer awareness.

It’s been a busy year, but it has all been worth it. To learn more, visit Ironcology.org. ◆

PHOTOS COURTESY OF DR. JONATHAN FEDDOCK

ISSUE#95 9

COVER

A

TRANSFORMATIVE

MOMENT IN

CANCER CARE

On July 29, 2015, KentuckyOne Health and U of L opened the James Graham Brown Cancer Center at Medical Center Jewish Northeast, expanding cancer services into northeastern Louisville and increasing capacity for the Brown Cancer Center.

10 MD-UPDATE BY ROBERT BURGE PHOTOGRAPH

The James Graham Brown Cancer Center expands its expertise to northeast Louisville, advancing access and cancer therapies regionally and globally

BY JENNIFER S. NEWTON

LOUISVILLE

he James Graham Brown Cancer Center has a long and successful history in Louisville and the region. According to Brown Cancer Center Director Donald Miller, MD, PhD, that legacy began in 1978 with Wilson Wyatt’s vision for creating the best cancer center in the region, so people did not have to travel outside Louisville or the state for specialty cancer care.

The center’s mission is simple, says Miller, “to provide state-of-the-art cancer care for patients in Kentucky.”

That vision expanded in July 2015 when KentuckyOne Health and the University of Louisville (U of L), who jointly operate the Brown Cancer Center, announced the opening of a second cancer center location at Medical Center Jewish Northeast in Louisville’s east end. Miller calls the expansion “a major milestone in extending the mission” of the center.

Mark Milburn, vice president of Oncology Services for KentuckyOne Health, says that partnership and the expansion are helping to bring to fruition the vision set forth by KentuckyOne Health’s president and CEO. “Ruth Brinkley was clear when she came to KentuckyOne that she wanted to expand access to all Kentuckians,” says Milburn.

Medical Center Jewish Northeast was a natural choice for the cancer center’s second physical location because much of the infrastructure was already in place. Chemotherapy infusions were already taking place there, and the outpatient center also had PET scanning, diagnostic, and laboratory capabilities.

Additionally, it was a rapidly growing suburban area that serves the northern and eastern edges of Jefferson County, as well as surrounding counties. Milburn says, “We saw it as a growing part of the county that would benefit from these services closer to home.”

Not only does the location off I-265 and Old Henry Road serve a new demographic of patients, it also provides some breathing room for the Brown Cancer Center, which was at capacity at its downtown location.

Rooted in Multidisciplinary Care

If there is an overarching philosophy for Brown Cancer Center services, it is multidisciplinary care. “All care at the Brown Cancer Center is multidisciplinary, meaning we have a team of physicians for each different tumor type,” says Miller.

Medical oncologist Beth Riley, MD, FACP, concurs, “We pride ourselves on multidisciplinary care at the Brown Cancer Center, and we’re trying to preserve specialty care at the Northeast location as well.” Riley is the director of the Breast Cancer Multidisciplinary Clinic and director of Clinical Operations at the Brown Cancer Center, and will oversee cancer services at Medical Center Jewish Northeast.

The team at Medical Center Jewish Northeast is made up of six medical oncologists and one radiation oncologist, all with University of Louisville Physicians.

Currently, the center’s plan is to start all patients at the downtown location for their initial visit and evaluation in the multidisciplinary clinics to form a treatment plan.

Once the plan is formed, patients can choose to have chemotherapy treatments and follow-ups at Medical Center Jewish Northeast because it is closer to their home or work, or simply because they value the ease of parking and access and the greener surroundings (treatment area windows open to views of green fields and trees rather than urban buildings) of the suburban location. Each patient will be

Dr. Donald M. Miller (left), Brown Cancer Center director, discusses a patient’s treatment with Ryan Bycroft, PharmD, BCOP, clinical pharmacist in Oncology at Medical Center Jewish Northeast.

Dr. Beth Riley, director of the Breast Cancer Multidisciplinary Clinic and director of Clinical Operations at the Brown Cancer Center, will oversee cancer services at Medical Center Jewish Northeast.

PHOTOGRAPHS BY BRIAN BOHANNON

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COVER discussed at the multidisciplinary tumor conferences downtown, getting the benefit of the entirety of the cancer center’s expertise.

The new location will provide chemotherapy; radiology follow-up, such as CT scans, PET scans, and bone density; and consultations with a radiation oncologist. In the near future, executives and physician leaders hope to add radiation therapy services, clinical trials, a second opinion clinic, and a patient resource center to the Northeast location.

“The primary goal of the new location is to grow the program and to be a destination for referrals,” says Miller. “By the end of two years, we hope to see as many as 25 patients a day at Northeast.”

Milburn concurs, adding the goal also includes providing “access to that level of subspecialty care closer to home.”

“We have a strong translational research program at the Brown Cancer Center and a lot of unique clinical trials that go through our multidisciplinary clinics.

Eventually our goal is to get clinical trial treatments at Medical Center Jewish Northeast that would not be available at other places,” says Miller.

Clinical Research Provides Novel Therapies for Kentucky, the World

The goal of the Brown Cancer Center’s clinical trial program is simple on principle but monumental in execution. Says Jason Chesney, MD, PhD, deputy director of the Brown Cancer Center, “Our goal is to reduce cancer morbidity in the state and globally.”

The opening of a second cancer center location is a stepping stone towards that goal. “The expansion of the Brown Cancer Center to Jewish Northeast means a lot for research and clinical trials and patient access.

It will make available the 150 clinical trials open at the Brown Cancer Center right now. But we are also expanding the clinical research program to include Catholic Health Initiatives Institute for Research and Innovation (CIRI) where our medical oncologists will accrue patients to nationwide trials at the northeast site. That’s another 100 trials,” says Chesney.

The center’s execution of its mission is twopronged – to develop new therapeutics and improve detection while cancer is at a more curable stage – and the timing could not be more appropriate. “Right now there’s a revolution occurring in oncology. Up to the last several years we’ve used surgery, chemotherapy, and radiation to treat cancer. We had some improvements in survival and quality of life, but we’ve not had the transformative moment where we can markedly reduce cancer-related deaths, and that’s changing right now,” says Chesney.

Chesney points to two new classes of drugs: immune checkpoint inhibitors and oncolytic viruses.

Immune checkpoint inhibitors block the antibodies 12 MD-UPDATE

that turn off the immune system. MD-UPDATE discussed two immune checkpoint inhibitors that target the checkpoint dubbed PD-1 in last year’s oncology issue #89. Since that time, two PD-1 inhibitors, pembrolizumab (Keytruda®) and nivolumab (Opdivo®), have been FDA approved for both melanoma and lung cancer. “What started in melanoma is spreading across multiple solid and liquid cancer types. The most recent data shows they are effective in colon, liver, breast, and head and neck cancers,” says Chesney. “I believe these two drugs are going to reduce cancer-related deaths in the US by about 15 percent.”

Oncolytic viruses, which are injected directly into tumors, act as an accelerator to stimulate the immune system. “We’re seeing dramatic results with just the oncolytic virus itself. If you add the oncolytic viruses and immune checkpoint inhibitors together, we’re seeing synergistic improvements in activity in terms of tumor regression and survival,” says Chesney.

Right now, the Brown Cancer Center is the number one site in the country for a trial of an oncolytic virus called TVEC with the immune checkpoint inhibitor ipilimumab (Yervoy®) in melanoma. Chesney says, “One hundred percent of patients are responding,” which is unheard of in cancer treatment.

The center is also working with industry sponsor Amgen to test the combination concept in multiple cancer types. They are opening a phase 1 trial to directly inject liver metastases with the oncolytic virus for the treatment of multiple cancer types including cancers of the lung, breast, colon, kidney, pancreas, and liver. The next step will be combining liver injections with PD-1 inhibitors.

“The importance of these trials for stage 4 cancer cannot be overstated. These trials are the one treatment modality that gives these patients hope for longterm survival,” says Chesney. And improving access and enrollment is a critical component of addressing cancer mortality. “Right now the estimate is that three percent of adult cancer patients enroll in clinical trials.

That needs to go to 50 or 75 percent,” says Chesney.

Comparatively 70 percent of pediatric cancer patients

Dr. Goetz H. Kloecker, director of the Lung Cancer Multidisciplinary Clinic, talks with patient Devona Hayes and her husband Tim Hayes at the James Graham Brown Cancer Center in downtown Louisville.

Right now there’s a revolution occurring in oncology. Up to the last several years … we’ve not had the transformative moment where we can markedly reduce cancer-related deaths, and that’s changing right now.

enroll in trials. “It’s my belief if you can’t tell a patient you have a more than 75 percent chance of curing them with the current regimens, then you should put them on a clinical trial,” says Chesney.

Another exciting aspect of the Brown Cancer Center’s research program is the use of tobacco to make cancer vaccines. The center has two vaccines going into early phase clinical trials in the next year to 18 months – one for cervical cancer and one for colon cancer. Miller describes them as “one of a kind in the world” and says they are oral agents that should be much less expensive than current treatments. “We think that will be important worldwide,” he says.

Breast Cancer Multidisciplinary Clinic

Breast cancer is the most common cancer in women.

Thankfully, advances in mammography, genetic testing, and new therapies are changing the way clinicians fight breast cancer.

The Breast Cancer Multidisciplinary Clinic at the Brown Cancer Center has recently added new practitioners and technology to fight the disease.

New physicians include a specialty fellowship-trained breast surgeon, Nicolas Ajkay, MD, who has been with the center for about a year and adds a new layer of expertise to the team, and a new medical oncology partner, Mounika Mandadi, MD. New technology includes the addition of tomosynthesis, or 3D mammography, in the diagnostic breast center at the Brown Cancer Center. Tomosynthesis is a new option in breast cancer screening that may enhance the detection of early breast cancers.

However Riley cautions, “Despite new advances, we still have a problem with at-risk women not receiving timely mammograms.” She encourages physicians to adhere to American Cancer Society screening guidelines, which say discussions should start at age 40, and all women should have regular screening by age 50.

Advances in genetic testing have identified genes that were not recognized just five years ago. “The field of genetics in the last couple of years has really expanded in terms of genetic testing available, as well as identified genes, which we now recognize put people at risk for breast cancer,” says Riley. Patients who screened negative for BRCA1 and BRCA2 in the past but have a strong family history should consider rescreening for newly identified genes, such as PALB2.

Genetic screening is available at the Brown Cancer Center, and genetic counselors are part of the center’s multidisciplinary clinics.

Clinical trials through the breast clinic are growing, and that means increased access to new developments.

“We are working on bringing novel therapies, including immune therapies, in the form of clinical trials to patients. This includes what I call ‘homegrown’ drugs that were developed by scientists here at the Brown

Cancer Center,” says Riley. The short-term goal is to extend these trials to patients at Medical Center Jewish Northeast.

Lung Cancer Multidisciplinary Clinic

Kentucky leads the nation in lung cancer deaths, and medical oncologist/hematologist Goetz Kloecker, MD, MBA, MSPH, FACP, says this translates to hundreds of new lung cancer patients for the Brown Cancer Center each year. Luckily, advances in screening and treatment of lung cancer are also on the rise.

“There’s a tsunami of research and progress right now,” says Kloecker, who is director of the Lung Cancer Multidisciplinary Clinic and fellowship program director for Oncology/Hematology.

As with breast cancer, the fight against lung cancer begins with screening. The Brown Cancer Center began its lung cancer screening program three years ago, before it became standard of care. Since then, 17 KentuckyOne Health facilities, including Brown Cancer Center, have been recognized as Lung Cancer Alliance Screening Centers of Excellence.

Kloecker says the problem with lung cancer is that 60-70 percent of cancers are found at an advanced stage of 3 or 4, rather than the curable stages 1 and 2. “Low-dose CT scans are very sensitive to find little nodules and early cancers not found by chest x-ray,” says Kloecker. “By doing a screening CT, you find it in the early stage and can remove it and have a much better change of curing it. That’s why mortality is reduced by 20 percent.”

On the horizon, Kloecker says the Brown Cancer

Dr. Jason Chesney, deputy director of the Brown Cancer Center, says cancer treatment is undergoing a transformative moment, where clinicians can markedly reduce cancer-related deaths.

PHOTOGRAPHS BY BRIAN BOHANNON

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COVER Center is working on a breath test and a blood test for lung cancer detection. The breath test analyzes chemicals exhaled in the breath to predict if a lung nodule is cancerous. The blood test evaluates the calorimetric profiles of blood plasma to detect cancer.

When it comes to treatment, the multidisciplinary clinic’s philosophy relies heavily on clinical trials to provide novel therapies. “We want to try new treatments and medications to get results better than the standard of care,” says Kloecker.

There are two immunotherapy drugs FDAapproved for lung cancer – pembrolizumab and nivolumab. “The treatment makes it impossible for cancer cells to hide from the immune system, so immune cells can attack it and slow the disease down and cause remission where all others have failed,” says Kloecker.

He also points to one particular treatment for squamous cell carcinoma that doubles life expectancy in patients who already failed chemotherapy and other traditional treatments.

The discovery of oncogene mutations that initiate cancer has led to the creation of targeted therapies that are often as simple as taking a pill to achieve remission.

“Unfortunately, we haven’t identified oncogenes in the majority of patients. It’s about 10 to 15 percent of the population where we can start with a pill to shut down cancer,” says Kloecker, but he is still encouraged by the prospects.

As part of a grant, the Brown Cancer Center is in the second year of a study exploring ways to improve lung cancer care in Kentucky. Unfortunately, one of the big challenges is that 20-35 percent of patients with stage 4 lung cancer do not get treatment. But there is a misconception that these patients are limited to rural areas of the state. “I can tell you it happens in non-Appalachian areas and urban areas. The stereotypes are not true. Untreated lung cancer patients are out there in the cities too,” says Kloecker.

The project includes analysis of why patients are not getting treatment (whether it be access, stigma, or the fatalism of patients or providers) and efforts to educate providers on the myths and facts of treatment advances. “Once primary care physicians and providers see that, it will hopefully change referral patterns, and the enthusiasm of physicians will transfer to patients,” says Kloecker.

The Power and Synergy of a Regional Network

The KentuckyOne Health and U of L partnership is particularly fruitful in cancer care, where the breadth of KentuckyOne’s reach throughout the state, coupled with U of L’s expertise and research portfolio, are making huge strides. “Our ancillary programs have seen the benefit. We have a single cancer registry across KentuckyOne,” says Milburn, which has increased 14 MD-UPDATE

PHOTOGRAPH BY BRIAN BOHANNON

Mark Milburn, vice president of Oncology Services for KentuckyOne Health, says opening a James Graham Brown Cancer Center location at Medical Center Jewish Northeast provides cancer services closer to home for a growing part of Louisville.

efficiency of data collection and submission.

Both Miller and Milburn point to the synergies between community and academic physicians as a benefit of the collaboration. Milburn says part of the leadership team’s job is introducing these physicians to one another to provide optimal care. An area Milburn is particularly proud of is specialty pharmacy. “We’ve worked hard to create specialty pharmacy programming with guidance from the Brown Cancer Center and from community-based physicians,” he says.

Having their own specialty pharmacy program allows them critical input and ultimately more control over outcomes in a growing area of cancer treatment.

Another example of the synergy is unified leadership. “All of our cancer programming is under the same operational leader, Nancy Bowles,” says Milburn.

“We have confidence we are providing the same level of quality everywhere because it is being overseen by the same leader across all facilities.” Physician leadership and oversight is also an important component of their success.

Education of patients and providers remains a priority. To continue to spread the word about advances in cancer detection and treatment, the Brown Cancer Center is expanding its website for patients and partnering with KentuckyOne to access their statewide network of referrals through primary care clinics and emergency departments.

Whether it be in prevention, detection, or treatment, the James Graham Brown Cancer Center is on the forefront of a transformative moment in cancer care. Its commitment to expand access to all Kentuckians and make discoveries that impact global cancer morbidity and mortality are certainly worthy of its mission. ◆

Patients who screened negative for BRCA1 and BRCA2 in the past but have a strong family history of breast cancer should consider rescreening for newly identified genes, such as PALB2.

Dr. Chris Glaser offers advanced breast cancer treatment options at one of Kentucky’s newest hospitals, Owensboro Health Regional Hospital.

By using advanced oncoplastic surgical techniques, Dr. Glaser can conserve breast tissue and work to save lives while making sure women are as happy with their appearance as before their cancer diagnosis.

This is not just about treating cancer today, but also looking to the future. That’s why Dr. Glaser works to educate current and future surgeons on the latest techniques, improving cancer care for years and even decades to come.

At Owensboro Health, Dr. Glaser is part of a team with immense expertise and experience across the entire spectrum of care–giving women a fighting chance at beating breast cancer.

BOARD CERTIFIED • American Board of Surgery, 1993-present • Fellow American College of Surgeons, 1996-present

Ridgecrest Medical Park 2801 New Hartford Road Owensboro, KY 42303

FOR MORE INFORMATION, CALL 270-683-3720.

Visit OwensboroHealth.org for more information and additional locations.

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Increasing Precision, Decreasing Treatment Times

James Eckman, MD, shares new technologies and multidisciplinary approaches to radiation therapy at Baptist Health Louisville BY MELISSA ZOELLER Nearly two-thirds of all cancer patients will receive radiation therapy during their illnesses1, and the Baptist Health Louisville Radiation Center is proud to offer its patients the newest technology and treatment services available.

James Eckman, MD, has been with LOUISVILLE

Baptist Health Medical Group and Baptist Health Radiation Oncology since 2009 and is excited about the therapy that is available to his patients.

“We offer two radiation centers for our patients, Baptist Radiation Oncology off Kresge Way at the main hospital in St. Matthews and Baptist Eastpoint Radiation Center in the east end of Louisville,” states Eckman. “Our staff includes four doctors, two physicists, seven therapists, three dosimetrists, nurses, and many others who are highly trained to help our patients navigate their cancer treatment.”

The centers are equipped with both standard linear accelerators and advanced linear accelerators that administer radiation.

The Varian Truebeam® Radiotherapy System is an advanced accelerator that offers a new type of Intensity Modulated Radiation Therapy (IMRT). “This new type of IMRT rotates around the patient’s body slowly, 16 MD-UPDATE

PHOTO BY GIL DUNN

providing therapy that is much faster and more comfortable,” states Eckman. “Because procedure time is cut down from 15 minutes to only about two minutes, the risk of tumor motion decreases as well, providing a much more precise radiation treatment.”

Baptist Health also has a Novalis®

Dr. James Eckman, radiation oncologist with Baptist Health Louisville, says new technology and a multidisciplinary approach to radiation therapy are decreasing treatment times and side effects for patients.

Radiosurgery unit, which provides a very high dose of radiation that lessens the amount of treatments a patient might need. “The Novalis was initially used for brain tumors, but now we are able to treat outside of cranial targets throughout the body, currently lung, spine, and liver tumors,” states Eckman.

“The machine delivers a high level, very precise radiation dose in one to five treatments as opposed to the standard radiation therapy of 25 to 30 treatments, providing better tumor control, fewer side effects, and increased patient comfort and convenience.”

Radiation therapy is an important part of the overall cancer program at Baptist Health Louisville and works hand-in-hand with other disciplines and services throughout the hospital. Most of the department’s patient referrals come from medical oncologists, and about 40 percent of patients are treated with combined

chemotherapy and radiation therapy.

“We’re in close contact with our medical oncology colleagues on a daily basis, so we have a finely interwoven cooperation,” adds Eckman. “We also have a multidisciplinary thoracic clinic (mainly lung and esophageal cancer), where we have the thoracic surgeon, medical oncologist, and the radiation oncologist working together evaluating the patients, so it streamlines the process of recommending therapy.”

The physicians also gather weekly at multidisciplinary conferences on breast, lung, and general cancer. Representing five different disciplines, medical oncologists, radiation oncologists, surgeons, pathologists, and radiologists come together to discuss the best therapy for five to six different cases each week.

On top of the center’s multidisciplinary care approach to cancer treatment, patients also have access to nurse navigators that help guide them through the treatment process, a PET scan for post-treatment checkups, oncologic social workers for ancillary problems that might arise, and a cancer resource center that can provide additional help, services, and information for patients as well as their family members and friends.

And the cancer center is always actively involved in clinical trials, researching different methods and ways to make treatment more effective and efficient. Eckman is currently the principal investigator for the NRG-B51 (RTOG 1304) federal breast cancer trial, studying breast cancer patients who have received chemotherapy that has cleared their lymph nodes and who might not need chest wall radiation therapy after mastectomy or nodal radiation after lumpectomy.

“With our multidisciplinary approach to fighting cancer and the new technologies and trials available, the side effects of radiation therapy have decreased significantly,” states Eckman. “Patients are now experiencing faster treatment times and shorter treatment schedules, which definitely gets them on the road to recovery much sooner than before.”

And we’re all thankful for that. ◆ 1 Physician Characteristics and Distribution in the US, 2008 Edition, 2004 IMV Medical Information Division, 2003 SROA Benchmarking Survey. ASTRO.org

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Building Bridges to Cancer Care

Norton Healthcare partners with UK HealthCare on cancer research and services for the benefit of Kentuckians BY JENNIFER S. NEWTON As the face of medicine changes, so too does the culture of collaboration. No one physician, practice, or medical center can do it all, so organizations are partnering together to reach more patients with more services. One such partnership is that of Norton Healthcare and UK HealthCare.

The partnership began several years ago with physicians migrating between the two systems to fill clinical voids in the state.

From that, the collaboration extended to research opportunities. Stephen W. Wyatt, DMD, MPH, who holds dual positions as vice president for research at Norton Healthcare and senior associate director for the Clinical and Translational Science Center at the University of Kentucky (UK), is a living example of this collaboration.

A native Kentuckian and UK alum, Wyatt spent most of his career at the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga. “I’m a dentist by clinical training with a master’s in public health with a cancer and epidemiology focus,” says Wyatt. In 1998, UK recruited him back home to the Markey Cancer Center, where he also became the founding dean of the UK College of Public Health.

Norton began recruiting Wyatt in 2013, and the birth of his first grandchild in LOUISVILLE

NEW LEADERSHIP FOR NORTON CANCER INSTITUTE

On November 1, 2015, Norton Cancer Institute welcomes a new Executive Director and Physician-inChief – Joseph M. Flynn, DO, MPH, FACP. Flynn, a medical oncologist specializing in blood cancers, is coming to Norton from The Ohio State University, where he worked for the past eight years. Before that, he served in the Army.

Flynn was attracted to Norton Cancer Institute because of the organization’s reputation for excellent care and the passion for quality he found while getting to know the people there. “Personally, I believe the way to have excellent health care is that every role in the organization needs to be valued, and every person needs to be valued. By bringing that cult of personality and helping everyone to understand our goal together is to bring

Stephen W. Wyatt, DMD, MPH, vice president for research at Norton Healthcare and senior associate director for the Clinical and Translational Science Center at the University of Kentucky (UK), acts as one of the bridges between Norton Healthcare and UK HealthCare.

transformative care to the region, that’s going to not only change care but bring a higher level of expertise in treating patients,” he says.

With a background in translational research, Flynn believes Norton’s high volume of cancer patients makes it a prime location for research opportunities.

“Eighty percent of cancer care in our country still occurs in local settings, so being able to bring novel therapies and exciting

translational research to patients in Kentucky and Southern Indiana is going to change the complexion of cancer care in that region,” says Flynn.

Of the partnership between Norton and UK he says, “Each organization brings unique skill sets and unique opportunities, and I think they augment each other in ways that are mutually beneficial. Really, the patients are the ones that win ultimately.” ◆

PHOTOS COURTESY NORTON HEALTHCARE

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Louisville in 2014 helped tip the scales. He describes his position as “a bridge between Norton Healthcare and UK HealthCare.”

As such, he splits his time between Louisville and Lexington.

Wyatt says he was surprised by the breadth of Norton Healthcare’s research program. “At any point in time, there are 750+ clinical studies ongoing at Norton.

For a large community hospital system, it has a surprisingly robust research program and a great research infrastructure,” he says.

Cancer studies make up the largest part of the Norton research portfolio, with 120 trials currently underway, including pediatric oncology studies through Kosair Children’s Hospital. Norton also brings a large volume of cancer patients to the partnership. “Norton has about 4,000 new cases of cancer each year, which

TARGETED TREATMENTS FOR CANCER is larger than the UK Markey Cancer Center, which sees about 3,000 new cases,” says Wyatt.

While many of Norton’s cancer studies are industry-sponsored, UK’s Markey Cancer Center is a National Cancer Institute-designated Comprehensive Cancer Center, providing enhanced access to national government-sponsored trials and the data support and analysis of an academic medical center.

Geographically, the collaboration means physicians in cities like Owensboro may be able to refer patients to Louisville rather than Indianapolis or Nashville. “Over time, this should open up a pipeline of studies to the Louisville area that makes a difference for physicians and patients in the more western and southern parts of the state,” says Wyatt. ◆

Call (502) 629-HOPE to refer a patient.

Learn more at NortonCancerInstitute.com.

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Killing It Softly

New cancer treatments offer greater effectiveness and less collateral damage BY JIM KELSEY “It’s like using a scalpel instead of a machete.”

We are used to seeing medical breakthroughs make a major splash, but sometimes the history and perception of a particular disease is so pervasive that public awareness changes slowly, even when it is a major change.

Such a change has come in oncology, says Jessica Moss, MD, of KentuckyOne Health Hematology and Oncology Associates. She says that targeted drugs have changed cancer treatment, drastically reducing the negative impacts that often came with chemotherapy – leading to her machete vs. scalpel analogy.

“Some of the biggest challenges are dealing with misconceptions from both patients and other physicians about what we can do for various cancers,” Moss says. “In some cancers, the prognosis is so much better than it used to be because of targeted drugs.”

And when she says “used to be,” Moss isn’t talking about 30 or 40 years ago. She’s referring to changes she’s seen just in the past decade since her graduation from University of Louisville Medical School in 2005.

Moss grew up in Glasgow, Ky. Both of her parents were physicians – her dad working in emergency medicine and her mom operating her own pediatrics practice. She and her brother, who is now an emergency medicine physician, followed in their footsteps.

Moss performed her residency at Vanderbilt, intending to specialize in gasLEXINGTON

LYMPHOMA VERSUS MYELOMA Lymphoma is a blood cancer of the lymphocytes, which can be either B cell lymphoma or T cell lymphoma.

Myeloma is a cancer of plasma cells. Plasma cells are differentiated B cells that have gone on to make

troenterology. But due to her experiences in her oncology rotations, she switched to oncology. She did a hematology/oncology fellowship at the University of Kentucky before joining KentuckyOne Health as a hematologist/oncologist.

Moss and Dr. Jessica Croley, who completed their fellowship together, decided to open a joint practice – KentuckyOne Health Hematology and Oncology Associates. It is a “small community practice” that operates under the KentuckyOne Cancer Center umbrella.

Combined, they see approximately 30-40 patients per day, as well as visit patients in the hospital before and after office hours. Moss estimates that 10 to 20 percent of their patients are benign hematology patients, and the rest are oncology patients, approximately half of whom are breast cancer patients. Over 90 percent of the practice is outpatient-based.

“With my cancer patients, I’m always

antibodies. Normal plasma cells make antibodies.

“Part of how a myeloma causes problems is that it produces too much of an abnormal protein, and it secretes it. And that protein goes on to cause kidney problems and bone problems,” says Jessica Moss, MD, hematologist/ oncologist. “Both of these are liquid cancers. They can go wherever blood cells go.

It’s not something we can cut out and be rid of.”

Moss says targeted drugs such as bortezomib, ibrutinib, lenalidomide, and rituximab are beneficial in treatment of lymphoma and myeloma. By targeting the specific cells involved in the growth, progression, and spread of cancer, they are offering significantly better prognosis and less toxicity to the patient. ◆

Dr. Jessica Moss of KentuckyOne Health Hematology and Oncology Associates at KentuckyOne Health says new targeted therapies are transforming cancer treatment.

up front with them about whether this is a cancer we can cure or a cancer we can treat,” Moss says. “Just because a cancer is not curable doesn’t mean we can’t treat it.”

Moss recently returned from the first annual meeting on hematologic malignancies by the American Society of Hematology.

A prominent discussion topic was the development of even more targeted agents that are offering an alternative to chemotherapy.

Traditional chemotherapy is designed to attack cells that are replicating, which also goes on in some normal cells such as those found in hair follicles, the inside of the mouth, gastrointestinal tract, and bone marrow. That accounts for the toxicity of chemotherapy causing patients to lose their hair and experience nausea, vomiting, and diarrhea.

“What we have now are drugs that are targeted against proteins that can be expressed either on the surface of cancer cells or within the cell as part of the signaling process that gives the signal to grow and PHOTOS BY GIL DUNN

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divide and act abnormally,” Moss says.

One example of these targeted drugs is ibrutinib. It is an oral drug that is targeted against a protein within that cell-signaling process called bruton tyrosine kinase.

“Nobody expects it to be a cure, but people are living much longer and with much less toxicity than they ever did with what would have been our second line chemotherapy agent,” Moss says. “In one patient, if we didn’t have this drug, I would be having hospice conversations with him.

But now I can help him and get him back to his baseline quality of life.”

Similarly, myeloma prognosis and survival are much better thanks to relatively new drugs. Moss tells of a patient who had fractured several of his vertebrae due to the myeloma destroying his bones. Treatment included radiation, steroids, and two drugs that have just come into use in the last decade – bortezomib and lenalidomide.

“One of the doctors rounding on him at that time told him that he would be dead within a year,” Moss says. “This was over two years ago. That man has gone into

complete remission. Initially, he and his wife didn’t want to go through this ‘toxic’ treatment since they were told he would be dead. I had to do damage control and say ‘no, really, we have better treatments now.’

But if you haven’t been in the oncology field, you haven’t seen that necessarily.”

A death sentence isn’t the only misconception that comes with a cancer diagnosis.

Another is how sick the treatments will make you. While the targeted drugs are much less toxic, the supportive care drugs are also much more effective against nausea, vomiting, and infection.

“I tell people, if you have vomiting, I’ve failed,” Moss says. “I expect you to have a functional independent life. If your quality of life is so poor that I’m doing more damage by the treatment than the cancer would have done to you, then I’m not doing the right thing.”

Patients aren’t the only ones with misconceptions about cancer treatments and prognosis. Physicians see oncologists like Moss in the hospitals treating the sickest of the sick, but not the ones that come to her clinic every day.

“It’s easy for other doctors to think all oncology patients are like those in the hospital, but that is less than 10 percent of my patient population,” Moss says. “Most of my patients will either be cured or will live for years, maybe even decades with their diagnosis.”

A scalpel instead of a machete. A disease instead of a death sentence. ◆

Hematology and Oncology Associates 3470 Blazer Parkway, Suite 150 Lexington, KY 40509 P: 859.629.7110

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20 MD-UPDATE

ymcacky.org/livestrong

SPECIAL SECTION  ONCOLOGY

Preservation and Precision

General surgeon Christopher Glaser, MD, FACS, employs oncoplastic surgical techniques and a new 3D tissue marker to improve breast cancer treatment in Owensboro BY JIM KELSEY For Christopher Glaser, MD, FACS, general surgeon with Owensboro Health’s One Health Surgical Specialists the decision to become a surgeon was all about being able to fix his patients’ ailments, not just treat them.

“Surgery is the only medical specialty we have where we actually cure people of their diseases,” says Glaser. “If a patient has diabetes, you can put him on insulin but he still has diabetes. But if someone has a bad appendix, you take the appendix out, and they are cured.”

A native of Louisville, Glaser attended the University of Louisville School of Medicine and completed his residency at the Medical College of Wisconsin. He was offered a position in Owensboro in 1993 and has practiced there ever since. He and his wife of 32 years have three grown children and love being part of the Owensboro community where Glaser practices as part of a nine-person general surgery group. “We do everything except brains, bones, and the heart,” Glaser says of his team. “Everybody has their own niche that they really like.

Breast surgery is my niche, and approximately half of my practice is breast surgery.”

OWENSBORO

Oncoplastic Surgery Improves Breast Preservation, Outcomes

Advancements in breast surgery have not only improved patient outcomes, but also have helped reduce the scars – both physical and emotional – that such surgeries can leave behind. “When I was a medical student, there were only two procedures – a biopsy and a mastectomy,” Glaser says.

“Now there’s always something better, and I find that very attractive.”

Gone are the days when a cancerous lump in a woman’s breast meant an automatic mastectomy. Today chemotherapy is often used to reduce the size of a tumor prior to surgery, and advances in oncoplastic surgery and radiation therapy are improving

the efficacy and aesthetic outcomes of breast preservation techniques. “When a woman has breast cancer, she shouldn’t fear what she’s going to look like after treatment. That’s the glory of oncoplastic surgery,” says Glaser.

When Glaser started at Owensboro, there were not any plastic surgeons in town,

is making sure you get a margin of normal breast tissue around the tumor,” Glaser says. “If you’re taking out a large amount of that breast tissue, you can imagine what it’s going to look like when you’re done. But using the oncoplastic approach, you can move tissue to fill that void, and you don’t have to be so conservative with your margins. When you have good margins, you have fewer problems with infection, pain, deformity, and recurrence.” And better margins during the initial surgery translates to better outcomes for patients.

BioZorb Improves Radiation Precision

“When a woman has breast cancer, she shouldn’t fear what she’s going to look like after treatment. That’s the glory of oncoplastic surgery,” says Dr. Christopher Glaser, general surgeon with Owensboro Health’s One Health Surgical Specialists.

so patients had to leave Owensboro for breast reconstruction. That led Glaser to seek plastic surgery training at a course in Dallas, Texas, where he learned oncoplastic techniques.

Oncoplastic surgery is the combination of plastic surgery reconstructive techniques with surgical oncology. Besides the aesthetic appeal, oncoplasty give surgeons the ability to resect wider margins. “The most important thing in surgical breast cancer

After the surgical removal of a tumor, radiation oncologists often give a boost of radiation to the area that housed the tumor. However, in the past, it was difficult to accurately judge where and how large that area was. “Before, the natural thing was to broaden the radiation treatment to make sure they got it all. The problem with that is the more volume you treat, the worse the deformity of the breast,” says Glaser.

Now, surgeons at Owensboro Health use BioZorb™, a three-dimensional tissue marker, to pinpoint the tumor’s precise location. A small spirallike device made of the same material used to make dissolvable stitches and embedded with eight titanium clips, BioZorb is sewn into the breast cavity vacated by the tumor to accurately mark its location.

Glaser and the radiation group performed a study, examining 12 cases prior to use of the BioZorb. “We discovered the average decrease in treatment volumes with the marker was three and a half times less breast volume,” he says.

Resecting tumors, while preserving breast volume and appearance? Now that goes a long way toward fixing the patient’s problem, not just treating it. ◆ PHOTO COURTESY OF OWENSBORO HEALTH

ISSUE#95 21

SPECIAL SECTION  RADIOLOGY

A New Dimension

Floyd Memorial Goes a Step Above by Offering Patients 3D Mammography and Stereotactic Breast Biopsy BY MELISSA ZOELLER With one in eight women having a chance of developing breast cancer in their lifetime, Floyd Memorial Hospital and Health Services in southern Indiana knew it was time to step up their game.

This past August, the hospital installed a 3D mammography unit in their Women’s Imaging Center. Already a leading Breast Cancer Center in the region, Floyd Memorial is accredited by the National Accreditation Program for Breast Centers (NAPBC), which is administered through the American College of Surgeons, and is a Breast Center of Excellence through the American College of Radiology. The center has obtained ACR guidelines in mammography, stereotactic breast biopsy, and breast ultrasound. Offering 3D Mammography was the next step in innovation that will continue to put the hospital on the forefront of technology in their community.

Sarah Leis, RT(R), (M), RDMS, RVT, radiology manager at Floyd Memorial with 15 years’ experience, says there were a few key reasons Floyd decided to purchase a 3D unit.

“Three-dimensional mammography has actually been out for a few years, but it was thought to only be useful for women who have very dense breast tissue,” states Leis.

“Recently The Mayo Clinic published a journal article focusing on a large multiyear tomography study that found 3D mammography to be beneficial not only for women with dense breasts, but normal breast tissue as well. That study, combined with the fact that the Centers for Medicare & Medicaid Services (CMS) put a CPT code on tomography, was exactly what we needed to make the leap into 3D imaging.”

Leis adds that Medicare is the only insurance provider currently paying for 3D mammography but is sure that others will follow suit, especially since it’s offering results like never before.

“We offer all our patients the 3D mammography option, billing their insurance the price of the 2D mammogram and only charging $60 for the additional portion of NEW ALBANY, IN

22 MD-UPDATE

the study. It’s a small price to pay for peace of mind,” adds Leis.

As Leis mentioned, the 3D mammogram technology was first thought to only be suitable for women with very dense breast tissue. Brian Worm, MD, a board-certified

that have dense breast tissue. We characterize breast density in a classification system of four categories: fatty breasts, scattered fibro-glandular densities, heterogeneously dense, and extremely dense,” states Worm.

“Three-dimensional mammography is very beneficial for those with heterogeneously dense and extremely dense breast tissue.

Fifty percent and above will show tissue density, which appears as white images on the study. Cancer also shows up as white spots, so it’s hard to tell the difference with 2D technology.”

A 2D mammogram takes a 3D object, the breast, and creates a 2D pic-

Brian Worm, MD, board-certified radiologist with Radiology Associates, Inc., says he has already caught two breast cancers with 3D mammography that were not visible on a 2D mammogram.

ABOVE

Sarah Leis, RT(R),(M), RDMS, RVT, radiology manager at Floyd Memorial Hospital, says a recent Mayo Clinic journal article on the benefits of 3D mammography plus the addition of a CPT code for tomography contributed to Floyd Memorial’s decision to add 3D mammography services to their Woman’s Imaging Center.

RIGHT

radiologist with Radiology Associates, Inc. in southern Indiana, explained the classifications of breast density and why the 3D mammogram unit will soon be the gold standard in mammography.

“Three-dimensional mammography makes a really big difference in patients

PHOTOS COURTESY OF FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES

ture out of four scanned images. The breast tissue imagery is superimposed one on top of the other. Three-dimensional mammography takes the four 2D scanned images and an additional four 3D images to reconstruct one-millimeter pictures of the breast, so each individual image can be studied and reviewed, much like a CT scan or MRI. “We tell our patients that 2D imaging is like viewing an entire book in one picture,” states Leis. “The front, the back cover, and

all the pages of that book are overlapping – been superimposed upon one another, you mography is still very good for looking at all in one image. What 3D allows the radi- might think you see a mass, or what we call calcifications in the breast that can also be ologist to do is to open that book and view an architectural distortion, and we may call precancerous. I would never have called the page-by-page. It takes these slices and allows them back because we think it’s abnormal. two cases back for additional views if it were them to see the breast slice-by-slice, so what But most of the time it ends up being noth- not for the 3D mammogram. Both of those may have looked like an overlapping density ing,” states Worm. “In patients that get 3D came back as documented, biopsy-proven before, now opens up and shows the ebb and mammograms, we can actually figure that cancers,” he says. flow of the breast tissue, revealing the really out beforehand because we’re looking at And because of a generous grant small breast cancers and given to Floyd finding those invasive Memorial by the 2D imaging is like viewing an entire book in one picture tumors a lot sooner.”

Floyd Memorial Floyd Memorial Foundation, an the front, the back cover, and all the pages overlapping. 3D sees it as an extra tool upright stereotacmammography allows the radiologist to open that book and in their technology tic-guided core 3D tool belt. For women view page-by-page … revealing really small breast cancers and biopsy unit will be that either have dense added to the 3D finding invasive tumors a lot sooner. breasts, a strong family mammography history of breast cancer, unit in October. or those women that are constantly called all these one-millimeter slices of the breast. Upright biopsies are more comfortable and back because of abnormalities, 3D mam- The call back rate is considerably lower.” take less time, but most importantly can mography is a great option.

And Worm has already caught two cases give an accurate diagnosis right at the And the results are already speaking for of breast cancer that were not visible on the moment the abnormality is found, lessenthemselves. Fewer patients are being called 2D mammogram. ing patient anxiety and improving detection back for follow up and cancers are being “At Floyd, we currently take a 2D outcomes. caught earlier than normal. picture and also a 3D picture. We’re getThe translation? A future with less can“When you see a patient with a 2D ting both pictures. The patient is actually cer, and that’s something we can all get mammogram, which has images that have still getting a 2D mammogram. 2D mam- behind. ◆

TESTIMONIALS “I was impressed with the feedback we received about our practice expansion into Louisville from the coverage in MD Update. While I expected to hear about it from colleagues, there was a great deal of response from friends and business associates who aren’t in medicine at all. Patients also love to see that their doctor is in a magazine.”

--- Thomas Stone, MD Partner, Retina Associates of Kentucky

“MD Update provides me with the latest trends in medical services, practice management and cutting edge technology in the state.

Reading it makes me feel like I am an active part of the regional healthcare community.”

--- Darryl Kaelin, MD, Associate Professor, U of L, Medical Director Frazier Rehab Institute, Division of Physical Medicine & Rehab

ISSUE#95 23

SPECIAL SECTION  RADIOLOGY

Mammography is Not Black and White

Richard Budde, MD, of KentuckyOne Health Breast Care, discusses the different shades of gray in breast cancer diagnosis and treatment and the advantages of 3D mammography. BY JILL DEBOLT LEXINGTON Almost everyone has been touched

by the diagnosis of breast cancer in a loved one. The potentially devastating results of this diagnosis underscore the need for high quality breast care for women in Kentucky.

Screening and early, accurate diagnosis remain lynchpins in the fight to reduce morbidity and mortality from breast cancer.

Drawn to Women’s Imaging

Richard Budde, MD, breast imaging specialist, joined partners Marta Kenney, MD, and Kimberly Stigers, MD, at KentuckyOne Health Breast Care in the fall of 2014. This practice, located at Saint Joseph East in Lexington, provides breast imaging services for KentuckyOne Health facilities. Budde’s passion is using his expertise to provide the best and most timely care to patients undergoing mammography and breast biopsy procedures.

Budde brings a wealth of radiology experience to the practice. A graduate of University of Cincinnati College of Medicine, Budde completed his diagnostic radiology residency in Pittsburgh and his interventional radiology fellowship at The Ohio State University. Coming from a medical family, his father is a retired neurosurgeon with Mayfield Neurological Institute, now known as Mayfield Clinic, in Cincinnati. Budde was drawn to the field of radiology by the technology boom in medical imaging during the 1980s. “I was attracted by the ability to deliver direct patient care through image-guided procedures,” says Budde. During his career in private practice in Cincinnati, Budde gravitated to the women’s imaging realm and served as section chief of Breast Imaging at the Christ Hospital. He came to Lexington for the opportunity to practice exclusively in breast imaging and intervention.

Detection of Breast Disease

Breast disease can run the gamut from 24 MD-UPDATE

PHOTOS BY GIL DUNN

benign tumors, fibrocystic disease, infections, and trauma to malignant disease, according to Budde. He describes the breast as a complex, glandular structure. “There are multiple shapes and forms of breast cancer, and on mammography it’s not typically as clear as black and white but more often displayed as many shades of gray in between. This highlights the importance of utilizing breast imaging specialists who are experienced in navigating the subtleties of mammographic interpretation,” states Budde. He adds, “The diagnosis of breast cancer is intricate from an anatomic, disease, and pathology standpoint.” Budde cites the fact that breast cancer affects one out of eight women. His patients, predominately female, come from a wide geographic area including central, east, and southeast Kentucky. While he does see patients in their 20s and 30s, most patients are ages

Radiologist Dr. Richard Budde joined KentuckyOne Health Breast Care in Lexington in the fall of 2014 for the opportunity to practice exclusively in breast imaging and intervention.

40-80, the common age spectrum for mammography screening. Budde adds, “I do see an occasional male patient. Breast cancer in males has an incidence of approximately one percent and can be familial.”

Budde recognizes the emotional impact of a breast cancer diagnosis stating, “It’s a very stressful moment in a woman’s life. We treat our patients with compassion and concern, and, in the event of a biopsy yielding atypia or malignancy, we assemble a team of specialists who develop a dedicated treatment plan as soon as possible.”

Annual Screening Still a Priority

Women are bombarded by the mainstream

media with multiple confusing recommendations about breast cancer screening. Despite controversies in the medical literature, Budde strongly believes in annual mammograms for average risk women between 40-75 years of age, stating, “The data from several landmark randomized controlled studies continue to support annual mammograms as an effective tool for significantly decreasing the morbidity and mortality rate of breast cancer.” This recommendation is endorsed by the American Cancer Society, the American College of Obstetrics and Gynecology, and the American College of Radiology. According to Budde, a high risk woman, generally defined as having a first-degree relative with breast cancer, should start annual screening 10 years prior to the age of diagnosis for their relative, but not before age 25. For women above age 75, the decision on screening should be made in conjunction with their primary care provider or gynecologist. Many older women who are in good health and have life expectancies of at least five-to-10 years, continue regular screening.

3D Mammography - The Gold Standard

KentuckyOne Health Breast Care uses 3D mammography, also known as tomosythesis, to provide state-of-the-art breast imaging services to their patients. Budde reports that early studies demonstrate tomosynthesis can improve early breast cancer detection in patients with dense breast tissue by up to 30 percent. He recognizes that mammograms are an anxiety-provoking experience, especially when recalling patients for additional images of suspected abnormalities.

“It’s important to treat the patient and not just the medical image,” notes Budde.

When suspicious abnormalities are noted, a biopsy can usually be scheduled on the same day. His practice was the first in Kentucky to have 3D biopsy capability.

This enables the patient to be seated upright

instead of lying prone for the typical 2D biopsy procedure. “Not only is the patient more comfortable, the breast imaging specialist can more easily biopsy certain lesions,

It’s important to treat the patient and not just the medical image. – Dr. Richard Budde

especially those close to the chest wall” states Budde. The ultimate goal is accurate and timely detection of breast pathology.

“We strive to shrink the time line down between diagnosis and starting a treatment plan,” adds Budde.

Budde eventually sees a conversion to 3D imaging for all mammography in the United States, saying “It will very likely become the standard of care.” Software improvements have advanced ultrasound and MRI technology in diagnostic breast imaging. In addition, treatment options have become much more specific with targeted therapies based on genetic and tumor markers detected on tissue biopsy specimens. Treatment options range from chemotherapy, radiation therapy, and surgery to hormone and molecular therapies and are personalized to the patient. “The good news for all women is that mortality from breast cancer has decreased 30-35 percent since the 1980s,” adds Budde.

Budde says he and his partners at KentuckyOne Health Breast Care strive to give their patients expert breast imaging care using a personalized approach that minimizes anxiety by avoiding unnecessary testing and providing timely results. ◆

Breast Care Saint Joseph East Medical Office Building 160 N. Eagle Creek Drive, Suite 101 Lexington, KY 40509 P: 859.967.5613 ISSUE#95 25

COMPLEMENTARY CARE

Top Five Regrets of the Dying Bronnie Ware’s book The Top Five Regrets of the Dying - A Life Transformed by the Dearly Departing is a memoir of her work in palliative care with patients who had gone home to die. “I was with them for the last three to twelve weeks of their lives,” she says. “People grow a lot when they are faced with their own mortality. I learnt never to underestimate someone’s capacity for growth.” Not only did Ware observe how her patients experienced growth as they were dying, she found herself transformed by the experience.

In her conversations with patients about any regrets they had or anything they would do differently, Ware found that five common regrets surfaced again and again.

LOUISVILLE

1. I WISH I’D HAD THE COURAGE TO LIVE A LIFE TRUE TO MYSELF, NOT THE LIFE OTHERS EXPECTED OF ME. “This was the most common regret of all,” according to Ware. “When you are on your deathbed, what others think of you is a long way from your mind.”

2. I WISH I DIDN’T WORK SO HARD. Ware says “All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence.

They missed their children‘s youth and their partner‘s companionship.”

3. I WISH I’D HAD THE COURAGE TO EXPRESS MY FEELINGS. James Pennebaker studied the effect of “keeping it all inside” on one’s mental and physical health and found that confiding in someone could be therapeutic in dealing with stress, difficult emotions, and painful memories. “There’s no greater agony than bearing an untold story inside you,” claims Maya Angelou.

4. I WISH I HAD STAYED IN TOUCH WITH MY FRIENDS. In 1985, people tended to have about three really close friends, as reported by the General Social Survey. By 2004, that number had dropped to only two close confidants. According to journalist David Brooks, the number of people who say 26 MD-UPDATE

they have no close confidants at all has tripled over that time. “People these days are flocking to conferences, ideas festivals and cruises that are really about buildBY Jan Anderson, PsyD, LPCC ing friendships, even if they don’t admit it explicitly.”

5. I WISH THAT I HAD LET MYSELF BE HAPPIER. This is a surprisingly common one, according to Ware. “Many did not realise until the end that happiness is a choice. Fear of change had them pretending to others, and to themselves, that they were content,” she observed.

I do once in a while,” Gretchen observed in a recent blog called Scheduling Happiness.

“In thinking about happiness, it’s easy to focus on exceptional events — the significant good or bad things that happen to me. However, I’ve realized that my ordinary, run-of-the-mill routine also has a huge influence on my happiness.” Recent research supports Rubin’s claim.

Begin with the End in Mind

As I reflect on the regrets of the dying, it’s really no wonder they (and we) lose sight of what really matters. “Most of us spend too much time on what is urgent and not enough time on what is important” observed Stephen Covey, who will be remembered most as the author of The Seven Habits of Highly Effective People. Covey proposed a backward design approach to life called begin with the end in mind. He suggested

Got Happiness?

When someone like Michael J. Fox says “Happiness is a decision,” we get the idea that he is talking about a way of life, not a temporary emotional state. As s������� ociologist Christine Carter puts it: Happiness is best thought of as a skill.” This is not a Pollyanna perspective about happiness; we develop this skill every time we respond with resilience to life’s inevitable challenges and difficulties.

Gretchen Rubin is an expert on choosing happiness. Rubin, who received her undergraduate and law degrees from Yale University, was editor-in-chief of the Yale Law Journal and clerked on the U.S. Supreme Court for Justice Sandra DayO’��������������������������������������� Connor��������������������������������� . She is author of the best-selling The Happiness Project: Or Why I Spent a Year Trying to Sing in the Morning, Clean My Closets, Fight Right, Read Aristotle, and Generally Have More Fun and creator of the popular blog The Happiness Project where she writes about her adventures as she testdrives studies and theories about how to be happier.

“One of my Secrets of Adulthood is: What I do every day matters more than what

Relationship and Life Strategy Expert Individual & Couples Counseling Relationship & Life Strategy Coaching Mindfulness-Based Cognitive Therapy

complimentary preliminary Consultation 502.426.1616 DrJanAnderson.com Jan Anderson, PsyD, LPCC

“The key is not to prioritize what’s on your schedule, but to schedule your priorities…

You have to decide what your highest priorities are and have the courage—pleasantly, smilingly, non-apologetically— to say ‘no’ to other things. And the way you do that is by having a bigger ‘yes’ burning inside. The enemy of the ‘best’ is often the ‘good.’”

Stephen Covey, an avid cycler, died in 2014 at the age of 79 from complications from a cycling accident. Even though he was wearing a helmet, he was knocked unconscious when he lost control of his bike on a steep road in the hills of Provo, Utah.

One of his famous sayings is “The main thing is to keep the main thing the main thing.” In his final hours, the father of nine was surrounded by his wife Sandra, each of his children and their spouses, “just as he always wanted,” the family said. ◆

D. Scott Neal,Inc. THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS

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ISSUE#95 27

NEWS  EVENTS  ARTS

Eichenberger Named CEO at Floyd Memorial

On October 1, 2015, the Floyd Memorial Hospital and Health Services’ Board of Trustees voted unanimously to remove the word “interim” from Dr. Daniel J. Eichenberger’s title, making him the CEO of Floyd Memorial Hospital and Health Services. Eichenberger, a longtime, local primary care provider in the community, was named interim CEO in March of this year, replacing Dan Fairley, who had also acted in an interim CEO position at Floyd Memorial from midDecember 2014 to mid-March after previous CEO, Mark Shugarman, resigned to take another position.

Eichenberger is board certified in both internal medicine and pediatrics, and he continues to practice part-time at Floyd Memorial Medical Group-Physician Associates of Floyds Knobs. In addition to his medical degree, Eichenberger earned his master’s degree in business administration in healthcare management in 2013.

NEW ALBANY, INDIANA

James Named CMO for Baptist Health Plan, Baptist Health Community Care

A physician with more than LEXINGTON

SEND YOUR NEWS ITEMS TO M.D UPDATE > news@md-update.com

30 years’ experience in health policy and health benefits has been named chief medical officer for Baptist Health Plan and Baptist Health Community Care.

Thomas James III, MD, assumed the CMO position on Aug. 31. He reports to Isaac J. Myers II, MD, chief health integration officer for Baptist Health and president of the Baptist Health Medical Group.

In the position, James provides leadership for all clinical and pharmacy activities for Baptist Health Plan and Baptist Health Community Care.

Baptist Health Community Care, housed at the Baptist Health Plan offices on Perimeter Drive in Lexington, has launched a pair of Care Advising programs to work one-on-one with plan members who have multiple or chronic health conditions, and with their providers as well.

James has firsthand insights into population health and clinical medicine, as he practiced internal medicine and pediatrics part-time during much of his career.

While at his most recent post – corporate medical director for clinical policy with Philadelphia’s AmeriHealth Caritas – he also worked in an after-hours clinic.

The Louisville native launched his medical career from the University of Kentucky College of Medicine after earning a bachelor’s degree from Duke University. He served internal medicine residencies at Temple University Hospital and Pennsylvania Hospital, plus a pediatric residency at

Children’s Hospital of Philadelphia.

Seventeen years of his career have been spent in Louisville, first as medical director for HealthCare of Louisville (later known as HealthAmerica Kentucky), then several positions with Humana, leading up to the post of medical director, national network.

Between those Kentucky positions, James spent a decade in Virginia, serving stints as medical director for Maxicare-Virginia/ HealthAmerica, Sentara Health Plan, and Travelers’ Health Network.

Blakely Named to Federal Advisory Board

Craig H. Blakely, PhD, MPH, dean of the University of Louisville School of Public Health and Information Sciences, has been appointed to the Defense Health Board, which advises the Secretary of Defense on matters relating to health for retired and active members of the military and their families.

Most of the board’s 18 members are retired high-ranking military personnel and physicians. Blakely, whose four-year appointment began in August when he attended his first quarterly meeting of the LOUISVILLE

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28 MD-UPDATE

NEWS

board, is the only member whose primary expertise is public health.

The Defense Health Board (DHB) makes recommendations and provides independent advice on operational programs, health policy development, health research programs, requirements for the treatment and prevention of disease and injury, promotion of health, and the delivery of health care to Department of Defense beneficiaries.

Blakely expects his knowledge of public health will allow him to make a contribution to the “big picture issues” addressed by the board, but he foresees the city and the university also benefitting from insights he will have into the concerns facing the military relating to emergency preparedness and global health issues.

Blakely joined U of L as dean of the School of Public Health and Information Sciences in 2013. He has overseen the U of L Office of Public Health Practice’s move into West Louisville and is the driving force behind a program to offer a U of L Master of Public Health degree in Lahore, Pakistan.

Prior to his arrival in Louisville, Blakely served for 26 years at the School of Rural Public Health at Texas A&M Health Sciences Center, most recently as dean.

He earned a doctorate at Michigan State University in 1981 and a Master of Public Health at the University of Texas in 1992.

He has published more than 40 articles and books on public health topics. He has served on the Nigeria Centers for Disease Control International Advisory Panel and is on the board of directors for the Association of Schools and Programs of Public Health.

Mannino Develops COPD Diagnostic Tool LEXINGTON According to Dr. David Mannino,

at least a third of Americans living with COPD discover their diagnosis after experiencing late-stage disease exacerbations. At this point, lung deterioration eliminates the possibility of intervention.

Mannino collaborated with a national team of public health experts to develop

a novel tool intended to hasten the process of detecting and diagnosing cases of COPD in moderate to severely impaired patients.

Maninno, professor and chair of the Department of Preventive Medicine and Environmental Health in the UK College of Public Health, led a team of researchers charged by the National Institutes of Health (NIH) Heart, Lung and Blood Institute with designing a direct and timely process for identifying cases of COPD in the primary care setting. As the presenting author on the project and principal investigator on the grant awarded by the NIH, Maninno reported on the findings from a study examining the effectiveness a five-step diagnostic tool during a meeting of the European Respiratory Society in Amsterdam on Sept. 29.

The three-year trial tested the diagnostic effectiveness of a simple patient questionnaire, as well as two common methods for diagnosing COPD: a peak flow examination and spirometry. Study results supported the five-series questionnaire paired with the peak flow condition as the most effective of the three diagnostic approaches.

Piper Named EVP/COO of Ephraim McDowell Health

DANVILLE Burt Piper, PharmD, FACHE, of Hammond, Ind., has been appointed to the position of executive vice president/chief operating officer of Ephraim McDowell Health. Piper assumed his duties on September 28, 2015.

Piper brings

to Ephraim McDowell Health more than 20 years of successful leadership experience in health care. Prior to joining Ephraim McDowell Health, Piper held progressive leadership roles at Franciscan Saint Margaret Health in Hammond, Ind. Piper earned his Doctorate of Pharmacy from Mercer University School of Pharmacy in Atlanta, Ga. He holds a Master of Business Administration from Ball State University in Muncie, Ind. He is a fellow in the American College of Healthcare Executives (ACHE), and is also a member of the American Society of Health-System Pharmacists (ASHP).

Tassin Named Saint Joseph Hospital President and Lexington Market Leader

KentuckyOne Health is pleased to welcome Bruce Tassin as the new president of Saint Joseph Hospital and the new Lexington market leader for KentuckyOne Health. With 25 years’ experience in hospital and health system administration, Tassin joins KentuckyOne Health from Christus Health Systems, a multi-state faith-based health system where he served a variety of roles throughout his career.

Tassin will be responsible for the implementation and engagement of the ongoing strategic plan for the facility, leading clinical and administrative teams to deliver safe, high quality care with compassion and respect. He will also handle implementation of the broader Lexington Market Strategy, impacting a range of KentuckyOne Health facilities across Eastern Kentucky.

A Louisiana native, Bruce earned both a BS and MBA from Northwestern State University in Natchitoches, La. Tassin is relocating to Lexington from New Mexico with his family and will begin his role on November 9, 2015. ◆ LEXINGTON

ISSUE#95 29

EVENTS

Lexington Medical Society Meeting -The September meeting of the Lexington Medical Society (LMS) had a robust turnout in support of the appearance by Lexington’s Steven J. Stack, MD, current AMA president. Stack spoke to the audience about three initiatives of the AMA for his term as president: a healthy, satisfied, and sustainable physician community; modernizing medical school education; and engaging physicians with the AMA message, mission, and vision.

Following his remarks was a question and answer session in which Stack commented on the burdensome and unreasonable nature of specialty re-certification process.

LEXINGTON

(l-r) Lesley and Henry “Chip” Iwinsky, MD, UK Orthopaedics, enjoyed being together at the LMS meeting.

(l-r) Richard Floyd, MD, wife Julie, and Tom Broster, MD, Central Kentucky Anesthesia Associates, at the LMS meeting.

(l-r) Tadd Hughes, MD, Kentucky ENT, David Kirn, Kirn Plastic Surgery PLLC, and Kathleen and Thomas Schwarcz, MD, Lexington Surgeons, paused for a group photo at the LMS meeting.

LMS President Rice C. Leach, MD, and Jitander Dudee, MD, Medical Vision Institute, before the LMS meeting. (l-r) Kathleen Twist, MD, UK Internal Medicine, with husband Christopher Simmons, MD, UK resident. Simmons was the winner of the LMS essay contest, residency division, and received a $1,000 prize.

(l-r) Steven J. Stack, MD, AMA president, with wife Tracie Overbeck, MD, PhD, Allergy Partners of Central Kentucky.

30 MD-UPDATE

PHOTOS BY GIL DUNN

(l-r) Dr. George Privett, Lexington Diagnostic Center and Open MRI, and Dr. W. Patrick Davey, newly joined with Dermatology Consultants, were at the September meeting of the LMS.

(l-r) Chris Hickey, LMS vice president and executive director, with Steven Stack, MD, AMA president, and David J. Bensema, CIO, Baptist Health and past president LMS and Kentucky Medical Association.

EVENTS

Lexington Clinic Golf

LEXINGTON The 11th annual Lexington Clinic

Foundation Golf Tournament, presented by Bluegrass Oxygen, was held on September 21, 2015. Over $100,000 was raised for allied health and healthcare administration scholarships and community initiatives.

One hundred and sixty players representing prominent regional and national companies participated in the tournament.

(l-r) Playing for the Med Pure team were Chris Zerbe; Leland Zerbe; Jerry Ruwe; and Rick Herbers.

(l-r) Playing for the Stites & Harbison team were Steve Ruschell; Al Gross; Gary Bello; and Chad Burnett. (l-r) Playing for the Baptist Health Lexington team were Rand Cimino; Monica Stahl; John Franke; and Vince Braddock.

(l-r) Playing for Dean Dorton were Kenny Craik; Mike Shepherd; Justin Sherman; and Will Booher.

(l-r) Enjoying the day at the Lexington Clinic Foundation Golf tournament were Dr. Scott Gibbs, grandson of Fergus Hanson, MD, Lexington Clinic’s longest serving administrator; and Robert Bratton, MD, current medical director for Lexington Clinic.

(l-r) Playing for Commonwealth Urology and Lexington Clinic were William Crowe, MD; Mark Dawahare; Charles Ray, MD; and Chuck Tunacliffe.

(l-r) Playing for Lexington Clinic were Andy Henderson, MD, CEO Lexington Clinic; and Tammy Ensslin, Foundation trustee; James Bottiggi, MD (ret); and John Sartini, MD.

(l-r) Playing for Bluegrass Oxygen were Wayne Colin, MD; John Dineen, MD; Bruce Broudy, MD; and Mike Marnhout, president, Bluegrass Oxygen and presenting sponsor.

(l-r) Playing for KY One Health and Saint Joseph Hospital were Ron Downs; Sue Downs; Eric Gilliam, president, Saint Joseph East; and Benny Nolen, president, Saint Joseph Mt. Sterling.

ISSUE#95 31

EVENTS

Hope Scarves Celebrates Colors of Courage

MD-UPDATE was a sponsor of the fourth annual Hope Scarves’ Colors of Courage event on Friday, September 25, 2015.

The event hosted over 500 guests, 11 of whom were breast cancer survivors and recipients of scarves from the Hope Scarves program.

The event raised over $125,000, $15,000 of which will go directly to research as part of the Hope Scarves Metastatic Breast Cancer Research Fund.

Even the rainy weather could not dampen the fun as guests enjoyed live music, cocktails, silent and live auctions, and catering donated by River Road BBQ. A special moment of the night was the recognition of women, who had either been recipients of scarves or had shared their own cancer stories with the program, holding luminaries. “It was important to us to connect back to our mission,” says Lara MacGregor, Hope Scarves founder.

The mission of Hope Scarves is to share scarves, stories, and hope with women facing cancer. When Founder Lara MacGregor was diagnosed with breast cancer, an acquaintance passed on the scarves she had worn in her cancer battle with an inspirational message that sparked the idea for MacGregor to pay it forward. To date, Hope Scarves has sent over 2,000 scarves, reaching every state in the US and nine foreign countries. The oldest recipient is 92 and the youngest is five.

(l-r) MD-UPDATE columnist Calvin Rasey and Matt and Amy Kerkhoff enjoyed the Colors of Courage event.

LOUISVILLE

Hope Scarves provides resources in three ways:

1 For patients – those facing a cancer diagnosis who will lose their hair or just need support can request a scarf, free of charge. Scarves come packaged with a cancer survivor’s story and tying instructions.

2 For hospitals and physicians’ offices – facilities can purchase scarf packages to distribute at the point of treatment so patients don’t have to seek them out themselves. The scarves are branded and customized with the hospital or facility logo and are available in quantities as small as 10. Promotional kits are also available for physician waiting rooms.

3 For survivors – cancer centers implementing survivorship programs can partner with Hope Scarves to collect scarves and stories to help survivors process, reflect on, and share their experiences.

For more information about the program, visit hopescarves.org. ◆

32 MD-UPDATE

PHOTOS BY BRIAN BOHANNON

(l-r) MD-UPDATE columnist Dr. Jan Anderson and MD-UPDATE Editor-inChief Jennifer Newton stayed out of the rain in the silent auction tent.

Dr. Patrick Williams, medical director of the Norton Cancer Institute, and Dr. Robert Hooker, interventional radiologist with DXP Imaging, supported Hope Scarves at the event.

Hope Scarves Founder Lara MacGregor and MD-UPDATE Editor-inChief Jennifer Newton at the Colors of Courage event.

MULTIDISCIPLINARY

LUNG CANCER CARE. LEADING CANCER CARE THAT TREATS YOU LIKE FAMILY. Treating you like family isn’t just something we say at Baptist Health Louisville. It drives everything we do. Here, patients get a team of multidisciplinary specialists who meet with them to determine the right treatment plans. All in one place. All in one day. Next, a dedicated nurse navigator supports the patient and family through every stage of care. With access to national clinical research trials and advanced lung cancer treatments, the team that treats you like family is right here.

LOUISVILLE

BaptistHealthLouisville.com/cancer