Healthcare in Hampton Roads by Darden Publishing

Healthcare November 2011 Edition

state-of-the-art

Cancer Care and TecHnology

Hampton Roads is now Home to tHe

largest proton beam therapy center in the world located at the Hampton University Proton Therapy Institute.

Local advancements in Medical TreaTMenTs www.dardenpublishing.net

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The Power of Protons…

…a cancer treatment that let me live my life.

“I played golf regularly during treatment and even flew planes. I have absolutely no adverse side effects two years after treatment.” – Ron Moreau Williamsburg, Va.

The Hampton University Proton Therapy Institute staff has over 100 years of combined clinical proton therapy experience. Proton therapy can target tumors with millimeter accuracy, sparing surrounding healthy tissue and reducing side effects. The largest of its kind in the world, the Hampton University Proton Therapy Institute is conveniently located in Hampton, Va., the heart of the Mid-Atlantic region; currently treating prostate, pediatric, head and neck and other cancers.

Experience the Power of Protons. 1.877.251.6838 www.hamptonproton.org

SERVICES FOR OLDER ADULTS ACTIVE LIFESTYLES & WELLNESS GoldenClub Membership Program Continuing Care Retirement Communities (Warwick Forest, Patriots Colony, Sanders) Riverside Wellness & Fitness Centers

POST-HOSPITAL REHABILITATION

I get treated at Riverside. With respect, dignity and understanding. Riverside wants you to always be in charge of your own health and well-being. That’s why we: • Ensure access to providers close by who gladly welcome Medicare patients • Empower physicians to truly respect and listen to your opinion • Offer the region’s largest continuum of health and wellness services for Older Adults • Connect you with a personal Care Navigator who can seamlessly coordinate the right services to meet your individual needs

Call Riverside Senior Care Navigation today -

757.856.7030

Riverside Rehabilitation Institute (Acute Rehabilitation) Riverside Rehabilitation Centers (Subacute/Skilled Rehab) Skilled Home Health Riverside Physical Therapy (Physical, Occupational & Speech)

RESIDENTIAL CARE FACILITIES Assisted Living Residences Convalescent Centers ClearPath Memory Support Programs

HOME AND COMMUNITY– BASED SERVICES Adult Day Services & Starlight Program In-Home Private Care (Private Duty, Companion Care) Riverside Hospice Pharmacy & Home Infusion Home Medical Equipment In-Home Technology (Lifeline, Medication Dispensing Service) Riverside PACE (Program of All-Inclusive Care for the Elderly) The Center for Excellence in Aging and Geriatric Health (CEAGH)

riversideonline.com Healthcare in Hampton Roads (full page) 7.25 x 9.875, color runs Nov.

FRom tHe pubLisHeR

Hello Neighbors

PUBlisHer

Paul Quillin Darden

ell...It finally happened. Five years ago, my three brother’s and I decided it was best for mom and the public’s safety to take mom’s car keys away. My mother, living in the house that we all grew up in and my dad built in 1953 with his bare hands, has lived there alone in Newport News since 1982 when dad passed away with diabetic complications. Mom also suffers from diabetes and a severe case of dementia. Yes, I forget where I put my cell phone all the time, so I guess it’s in my genes too. We did our best in keeping mom comfortable: taking over her financial responsibilities, making sure she took her medications and self administering her diabetic blood monitoring.

eXecUTiVe cHief ediTor Medical research director

The day finally came when the family did not have the time nor financial resources to maintain her health and safety. She insisted on staying in her home. We sought out the services of the PACE program on the Peninsula and I was immediately awed at what Riverside’s PACE program offered. I have been told by my wife, an employee of Chesapeake’s Social Services for almost 40 years, that Sentara was the first to offer the PACE program with services to residents living on the Southside of Hampton Roads. My mom being on Medicaid, Medicare and a small fixed social security income qualified and was accepted into their program. We had Home Care attendants arrive in the morning and evening to keep her on schedule with her daily regimen. This included daily transportation to the PACE facility in Hampton for recreation, physical therapy, and numerous other supervised activities. She was living a life again and was well taken care of seven days a week from 7am to 7pm. The evenings became our only concern as she still insisted on living in her home.

Brian Cole Paul Darden Natalie Miller Moore A.J. Plunkett

Just recently the inevitable happened. She fell and broke her hip. She had corrective surgery at Riverside Regional Medical Center and is now in Riverside’s rehabilitation facility “The Gardens”. We will soon, for her health and safety, move her into one of Riversides’ independent living facilities where she will continue to be closely supervised for the best health care a family can expect. God Bless you Mom..., we only want you to be happy... and on the surface it seems she is. Thank you PACE for everything you do.

Natalie Miller Moore coPy ediTor

Colleen Cooper Russell arT direcTor

Sherril Schmitz conTriBUTinG WriTers

coVer PHoTos

Hampton University Proton Therapy Institute

©Copyright 2011 by Darden Publishing. The information herein has been obtained from sources believed to be reliable: however, Darden Publishing makes no warranty to the accuracy or reliability of this information.

Healthcare in Hampton Roads is a bi-annual publication with current distribution to area Chambers of Commerce, and a delivery program to selected health related businesses throughout Hampton Roads. To obtain a copy or to find a location nearest you, please contact:

Well, I am still here to inform you that you can get the best medical advice with some of the best senior care, skilled surgeons and medical facilities right here in our own backyard of Hampton Roads, Virginia. Healthcare in Hampton Roads is my newest publication with a mission to spread the word about local health awards, accolades and quality of healthcare now available for people of all ages. I see it every day when I visit the sick and listen to their stories of how our health professionals from Hampton Roads saved a life or recommended a new procedure that put bounce back in their step. In upcoming editions we will present national health concerns in a way that you can understand and hopefully share your newfound knowledge with family and friends so we all can live longer, healthier lives with confidence that we are in good hands right here in Hampton Roads. Look for future issues featuring DIABETES and ARTHRITIS/JOINT PAIN. To good Health!

paul Q. darden, publisher

www.dardenpublishing.net

darden PUBlisHinG 931 A Shoal Creek Trail Chesapeake, Virginia 23320-9483 (757) 389-5473 darden.publishing@cox.net www.dardenpublishing.net

Healthcare features

Cover Story State-of-the-Art Cancer Care in your own Backyard

Locally, the latest advancements in cancer screenings and the latest diagnostic tools are available, including 64-slice CT scanners, PET scans, and MRI machines. The latest therapy options include focused-beam radiation and a Gamma Knife速 center, and there are plans for a new linear accelerator.

State-of-the-Art Technology Hampton Roads is home to at least two exceptional pieces of technology aiding in advanced cancer care: the Gamma Knife速 and proton beam therapy.

Early Detection can be Worth a Pound of Cure

Coping with Cancer: You are not Alone

Navigating Cancer Care

Care at Home Delivers Health Care and Help

Clinical Trials: A Legacy of Science

Cancer Programs in Hampton Roads

departments

Senior Living PACE - Program of All-Inclusive Care for the Elderly

26 26

Nutrition and Wellness Physical activity is central to reducing your risk of cancer.

Healthcare in Hampton Roads

By natalie Miller Moore

there is an erroneous belief in the Hampton Roads area that if you are diagnosed with something serious, like cancer, you should immediately book a plane ticket and head for Johns Hopkins, the mayo Clinic or duke university Health system. depending on the type of cancer you have, people might tell you to try md anderson in Houston or dana-Farber in boston. these are all exceptional hospitals. but many people in Hampton Roads may be surprised to see the innovative Hampton Roads and high quality care that’s right here in their backyards. is now home to the largest proton beam

Locally, the latest advancements in cancer screenings and the latest diagnostic tools are available, the world, located including 64-slice CT scanners, PET at the Hampton scans, and MRI machines. The latest therapy options include focused-beam University Proton radiation and a Gamma Knife center, Therapy Institute. and there are plans for a new linear accelerator. Hampton Roads is now home to the largest proton beam therapy center in the world, located at the Hampton University Proton Therapy Institute. Additionally, clinical trials for

therapy center in

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chemotherapy are ongoing at sites all over Hampton Roads. charlie Hill experienced this in the past decade as he had to deal with cancer several times. His wife was diagnosed with lung cancer in 2001 and passed away in June 2002. Just weeks after her funeral, Charlie got the news that he had prostate cancer. “The lesson from my wife’s cancer was that we didn’t know early enough to prevent metastases,” he said. As a result, Hill embarked on a comprehensive search for information about prostate cancer. He got two local opinions and then went to Johns Hopkins for a third opinion.

coVer sTory “At that time, I wanted the gold standard. I researched physicians and selected one who had done at least 200 procedures. I went to Baltimore for the surgery,” Hill said. Hill had done his research, and at the time, what was most important to him were the statistics on who was most experienced in treating prostate cancer. His surgery was deemed successful. But in 2006, Hill had a reoccurrence. He continued to work with his local doctors, including a radiation oncologist from EVMS. Hill found that the cancer care he received locally was the same caliber as what he had traveled to receive. “I was not surprised that advanced care was here. It was just a matter of uncovering what’s here. I knew there were a few people here who had international reputations in urology and prostate cancer, including a doctor who was the president of the American Urological Association, a doctor who personally experienced prostate cancer. I think this further enhanced what can be done for prostate cancer in this area,” Hill said. “I think Hampton Roads should be a national destination for diagnosis and treatment of prostate cancer, but it’s not well understood locally or around the country. I did my research to know this, but lots don’t,” Hill said. Jaime Reigler, marketing specialist from Virginia Oncology Associates, agrees with Hill. “You can stay here and get the best treatment. As a community, it’s all here, care at home, in your backyard. VOA offers state of the art radiology, outpatient cancer care, and numerous clinical trials, including some phase one trials that are cutting-edge medicine. leeanne Dalton, the Administrative Director of the Bon Secours Oncology Services, said although the perception is that cancer care can be better elsewhere, that option should really be reserved for specific circumstances. “You don’t have to travel to Mayo or Cleveland, unless that is something your provider decides for you. And I truly believe that our doctors are committed to making sure patients get the best care – it’s priority one. But in nine out of 10 cases, I think that patients will find what they need in the Hampton Roads area,” Dalton said. “We have some incredibly skilled expert surgeons, and a lot of them come out of those bigger programs. This area is attracting high-end surgeons, and we have cutting-edge

technologies. There are some non-tangible benefits to being able to complete treatment close to home and maintain that hometown support network,” Dalton said. When Sherry Rousselle was diagnosed with breast cancer four years ago, at the age of 36, she was scared but confident in her health care team. “I think the resources here are incredible. I don’t see why you’d go somewhere else, unless it’s a rare type of cancer that’s never been treated here,” Rousselle said. She said her experience was well-coordinated and the people who worked with her at Riverside helped her find her way even though she was at times overwhelmed. “The Cancer Care Center is one place for everything,” Rousselle said. “I spent an hour with a nurse who goes over what to expect. And there was nutrition counseling, massage therapist, and counseling. I did all my treatment there. And if you are there for any reason and you have another question about what’s going on, they can help with anything. You can take yoga classes specifically for people going through chemo, learn how to apply makeup when you lose your eyebrows. There are classes all the time.” Rousselle, delighted to be 40 with no evidence of disease, said she’s had time to reflect on her experience. “In four years, I’ve had a lot of time to think. “Would I have done anything different? No, I wouldn’t have,” she said. Rousselle was treated by oncologist Dr. Kim W. Schlesinger, Director of the Breast Cancer Program at Riverside, who said one of her most important goals is “to meet the patient where they are.” That’s one of the benefits of a move toward integrated cancer care. Riverside, as well as other area hospitals, follows an integrated model of cancer care in order to serve patients more holistically. Sofia Mikac, the Integrative Oncology Manager for Peninsula Cancer Institute, named nearly a dozen services that patients can be connected with through the Institute. The center puts all the resources in one place – and you can see that it’s a bit different just from the waiting room. It has trays of cookies, jigsaw puzzles in progress on a table, and quilts decorating the walls. The way people greet each other, both staff and patients, rings of familiarity and caring. “We’re here to focus on the cure, and this is where it all comes together. The treatment of the patient and the family, we are on this journey together,” Mikac said.

in YouR own baCkYaRd

cAnceR confeRenceS

PHOTO COURTESY OF NATALIE MILLER MOORE

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At the Cancer Institute, the cancer-care team works with patients on education, medication management, and side-effect management. But there are also have staff social workers, dieticians and therapists to assist with other important life issues. For example, social workers can arrange transportation for patients who need it. And access to a dietician means patients can get immediate help improving their diet, and have a resource for later when they may be having side effects that affect their diets. Among other services, the Institute provides massage therapy, stress reduction, yoga, instruction in self-meditation, and psychological counseling. “These are complementary therapies, not alternatives,” Mikac said. “Fear of the unknown, stress, pain, and anxiety are major issues for people dealing with cancer. And if we can help with those, we can help them more effectively complete treatment.” While receiving chemotherapy in the office, patients are made as comfortable as possible, with access to a movie library, and good company in the form of therapy dogs. They also cHKD tries to make cancer treatment as have the talents of a music coordinator, entertaining as possible for their young who will put together a customized patients. playlist for each patient — whether they want soothing classical music or energizing rock ‘n’ roll. Research has shown that listening to music can reduce pain and anxiety for patients. “We want our patients to call us whenever they have a question. They sometimes feel like it’s only happening to them. We may be able to help, and we are available for questions anytime,” Mikac said. The integrated model also includes referrals to even more resources, including those for family members, such as support groups and genetic counseling. These resources combine with advanced medicine to help patients beat cancer. “When I entered oncology, I wanted a field where I could get to know a patient over the longitude of care but one that also had a leading edge to it,” Schlesinger said. Hampton Roads is also lucky to have a resource for children who are diagnosed with cancer at CHKD, the Children’s Hospital of the King’s Daughters. The hospital, located in Norfolk, specializes in care for kids up to age 21. Much of the equipment is designed especially for children, such as the CAT scan with lower radiation settings to avoid giving an adult dose to a small child. The cancer center is also child-friendly – not just in the brightly colored décor – but also in the amenities provided for children who have to be there for cancer treatment. Amya Petrel, age 4, is receiving her chemotherapy via IV while playing video PHOTOS COURTESY OF CHKD

All over Hampton Roads, teams of medical professionals are meeting to discuss cases in multi-disciplinary conferences. The surgeons, radiation oncologists, pathologists, radiologists, medical oncologists, dieticians, patient navigators, social workers, and medical residents gather to figure out the best way to proceed or follow up with a cancer case. This means that patients are getting input from a team of experts (effectively second, third, and fourth opinions) on their treatment plans. Sentara’s cancer conferences review most cases, including 100% of head and neck cancers, which, typically, are complicated. cheri Hinshelwood, of Sentara Corporate Communications, explained that there are 20 cancer conferences covering eight different specialties across Sentara Healthcare, and that it’s a unique situation to be able to have specialty pathologists with experience in those specific cancer types reviewing cases. During the conference, doctors, med students, and staff discuss each case with a “here’s what we know, and here’s what we don’t” approach. They view CT scans, MRI results, pathology slides, video and photos of the patient case and ask each other for input. If there are any relevant factors, such as the patient skipping chemo treatments or dealing with homelessness, they add those to the discussion and brainstorm the best ways to manage that. The goal of the cancer conferences, and similar ones across Hampton Roads, is to assess patients prospectively. That means that a patient case gets scrutiny and attention in the beginning so that the best course of action can be decided. Marc Silverberg, a pathologist for Sentara, said that achieving 100% prospective – rather than retrospective –views on patient cases is “the Holy Grail.” Looking back on what could have been done isn’t nearly as helpful as getting each case in front of the team while there’s still time to treat the cancer. Sentara’s head and neck team is achieving that Holy Grail, reviewing all head and neck cancer cases at their conferences.

CoveR stoRY games on a banquette with her brother. Her parents, Carla and John, are nearby. They said Amya has spent a lot of time at CHKD in the past year, and was admitted for several months last year. Although it was a difficult time, they said being at CHKD made it a bit easier. “She was here for Halloween and they had their own trick-or-treating for her. And when it was Christmas she got gifts from the Ronald McDonald House. The nurses are so great. They’ve brought her stickers or nail polish because they know it will make her day,” John Petrel said. The family travels 60 miles each visit from Gloucester on the days that Amya has treatment, but they said it’s worth it. “If I had to be in a hospital, it would be here,” said carla Petrel.

Health care in Hampton Roads has proven to be both modern and patient-centric. Patient navigation of the health care system and integrated, one-stop-shop cancer centers are trends that continue to grow to meet the needs of cancer patients in this area. “No two cancers or cancer patients are the same,” Dalton said, “so it’s important to take the individual into account.” The hospital systems of Hampton Roads are making great strides in leading the way in cancer care. And that’s hopeful for everyone living in this region, whether their lives are touched by cancer or not. “I think people think of cancer as depressing and scary, but there is also an incredible amount of hope. Thinking about the patients’ courage keeps me going,” Schlesinger said.

caption.... PHOTO COURTESY OF HAMPTON UNIVERSITY PROTON THERAPY INSTITUTE

state-of-the-art

TECHNOLOGY comes to Hampton roads

Hampton Roads is home to at least two exceptional pieces of technology aiding in advanced cancer care: the Gamma knife® and proton beam therapy. both these high-tech tools use radiation to kill tumors, a common way to treat cancer-related tumors. but the science behind them and the way they are used make them very different from conventional cancer treatments.

Hampton University Proton Therapy Institute (HUPTI) is the largest and most advanced of the nine such centers in the United States. Proton therapy is the most precise form of radiation treatment, because it targets tumors while sparing surrounding healthy tissue, causing fewer side effects than traditional therapy. Use of proton therapy is growing, especially for pediatric cancers. cynthia Keppel, the Scientific and Medical Director for HUPTI, explained how the protons are used and customized for the specific location, size, and shape of the tumor. “The protons are delivered by an external beam. It’s a subatomic particle and a very low dose. But if you use multiple beams aimed at the same area, the radiation is all deposited in one area, making it a high dose only in that spot,” she said. Proton therapy releases the majority of its destructive energy within a small range inside the tumor, depositing less dose upon entrance and no dose upon exit. This way, it is possible to deliver more radiation to the tumor without harming healthy tissue around it. Keppel said patients feel fewer side effects from this treatment. Healthcare in Hampton Roads

PHOTO COURTESY OF RIVERSIDE HEALTH SYSTEM

CoveR stoRY

One of Kersh’s other arguments “Think of an X-ray where there’s an for treating cancer locally is the great intersection of lines of radiation. The working relationships the neurosurintersection is where the highest dose geons have with other programs naof radiation is, but it bathes the rest tionally. “Go ahead and get a second of the body in X-rays. With proton opinion, but also investigate treatment therapy, the dose is in the tumor, so the here,” he said. “We work with UVA, surrounding healthy tissue is unafJohns Hopkins, and teams nationally. fected,” she said. We also get patients from all over.” One of the major concerns, The Gamma Knife® at Riverside especially with pediatric patients, is that the radiation from treating cancer was installed in 2005, with the Synergy today could cause a secondary tumor -S® the next year. There are only 220 down the road. In fact, a Virginia Beach Gamma Knives® in the world and only couple, Susan and Jim Ralston, started a small number of neurosurgeons the Pediatric Proton Foundation to trained to use them. Dr. Kersh is one improve access to proton therapy after of them. their 2-year-old son was diagnosed The Gamma Knife® delivers with cancer in 2007. They lauded the focused and highly accurate beams Kelly Spencer, medical physicist, demonstrates the gamma Knife® opening of a local proton-beam center. of radiation to a specific area of the equipment in the lab at Riverside. HUPTI treated its first patient in August brain, as an alternative to conventional 2010, and is now fully functional. brain surgery, which can be invasive “A center like this is really exciting. I think it’s raising the whole due to cutting open the skull to access the brain. “Radiation oncology is profile of the Hampton Roads area,” Keppel said. She credits the vision essentially applied nuclear physics. It uses 3D thinking, and it’s precise to and passion of Hampton University’s president, Dr. William Harvey, with a sub-millimeter,” Kersh said. The process involves a lot of measurements making this project a reality. of the head, including calculating the size and shape of the tumors. Dr. Allan Thornton is a radiation oncologist at HUPTI and he has During the procedure, which takes one to two hours, 201 individual worked in Proton therapy for the last 20 years, including at the Harvard beams of cobalt radiation meet at a single focal point in the patient’s Cyclotron Laboratory and the Indiana University Cyclotron Facility. brain. The radiation hits the target directly, without damaging the surThat makes HUPTI the third center he’s worked at, out of the nine rounding tissue. The Gamma Knife® essentially kills the tumor. All that’s in the country. “I’m lucky to have an experienced staff at this unique left is a small scar, or nothing. resource,” Thornton said. Kersh likes to joke that the Gamma Knife® is the “uncutting edge” HUPTI is freestanding and not affiliated with any hospital systems of medicine. “The results are the same as surgery. The alternative is cut– making it a true community resource. “I see this as a regional center, ting open your head and spending two weeks in the ICU,” he said. The and there are a number of centers that send patients here. It’s a shared Gamma Knife® is a non-invasive alternative, and patients often resume resource, and I think that’s a different concept, but a good one,” he said. normal activities the next day. He said nearly 75% of patients come to HUPTI without being Besides brain tumors and lesions, the Gamma Knife® can be helpful referred by a doctor. Thornton thinks that shows patients are becomfor other neurologic conditions, such as temporal lobe epilepsy (where ing more involved in their care. Many times they’ve researched proton seizures originate from one point in the brain,) certain movement disortherapy on the Internet on their own. ders and obsessive-compulsive neuralgia (commonly known as OCD.) Referrals to the center don’t come just from the region or the East The Radiosurgery Center sees about 350 cases a year for 10-15 different Coast. Thornton said he’s had patients from all over the world call him, diseases, and, Kersh said, they’ve seen some incredible responses. and he’s currently treating patients from the United Arab Emirates, Russia The future of cancer care is looking brighter, as state-of-the-art techand India. nology continues to grow in this area. Recently, Bon Secours announced Another nationally known cancer resource here in Hampton Roads plans for a cancer center expansion at Maryview with a state-of-the-art is the Radiosurgery Center, a partnership between Riverside and the Varian TrueBeam linear accelerator, a radiation therapy unit, and addiUniversity of Virginia, which includes the Gamma Knife® and the tional equipment that is not currently available in Hampton Roads. Synergy- S® linear accelerator. The combination of technology is rare. According to Dr. Ron Kersh, head of the center, there are only eight facilities in the world with both. And one of them is located right here in HUPTI: http://www.hamptonproton.org/ Hampton Roads, on the Riverside campus in Newport News. Gamma Knife: http://www.riversideonline.com/rrmc/radiosurgery_ “I’m not sure why this area has such an inferiority complex. We can center/gamma-knife.cfm build submarines. Why not treat your brain cancer here, too? You don’t Pediatric Proton Foundation: http://pediatricprotonfoundation.org/ necessarily need to travel to get advanced health care,” Kersh said. 8

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By natalie Miller Moore

manY FoRms oF CanCeR Can be suCCessFuLLY tReated iF deteCted eaRLY. Local providers offer information and services for early detection. that colonoscopy or prostate exam is a small inconvenience compared to the benefits of having them done in a timely manner. it could save your life.

ngela Duke, Community Outreach Coordinator for Sentara, coordinates screenings across Hampton Roads, and her slogan is “pay now or pay later.” “I tell people that by the time we find a cancer later, it could be too late, and they could be out of options by Stage 4.” Duke is living proof of this, and she uses her own diagnosis of breast cancer and three reoccurrences as a cautionary tale for reluctant patients. “I was proactive, and that’s why I’m still here today. It’s important to be familiar with your body, do self-checks, and talk to your doctor. If you can be familiar with your body, you can let your doctor know when changes happen and get ahead of that,” Duke said. Besides monthly screenings that are focused on, say, oral cancer awareness in April, Duke and her team also blanket churches, community centers and schools with information, fliers and ads for their screenings. Last year, Duke and her team set up a tent at the Richmond International Speedway to reach

people who use tobacco to screen them for head, neck, and oral cancers. Here are some common screenings. You can also get more information about screenings recommended by the American Cancer Society. Talk to your doctor about when you should have them done. Breast Cancer: Annual mammograms are recommended after the age of 40, depending on family history. The American Cancer Society recommends that some women — because of their family history, a genetic tendency, or certain other factors — be screened with MRI in addition to mammograms. Mary Beth gibson, from non-profit organization Beyond Boobs, said, “Know your history, but know yourself.” Breast self-exams once a month can help women keep track of changes in their breast tissue. Being able to provide that information helps doctors track the rate of growth of tumors. Healthcare in Hampton Roads

Cervical Cancer: Women should have Pap tests regularly based on age, sexual activity, and history of test results.

Men with a history of prostate cancer in their families or who are African-American should begin earlier, around age 45.

Skin Cancer: People with fair skin or a family history of skin cancer should get checked annually by a dermatologist. The screening consists of a head-to-toe exam to look for changes in the skin and suspicious lesions or moles. In between screenings, look for discolored or notched moles, changes in your skin such as red patches, and any changes to existing moles. Nurse practitioner Deborah Quinn, of Pariser Dermatology, emphasized early detection. “The earlier you can detect it, the easier it is to remove or treat,” she said. Quinn said although melanoma is the type of skin cancer most people are familiar with, the carcinomas (squamous and basal cell) are most common. She said, however, melanoma is becoming more common due to decreased protection from the ozone layer, increased use of tanning beds, and people living longer. Even people with darker skin should be on the lookout for changes in their skin. Other people with increased risk of skin cancer include those whose immune systems have been compromised by taking certain medications (such as after an organ transplant) or have worked with chemicals such as arsenic. Quinn said the best way prevent skin cancer is to protect your skin with sunscreen, especially blockers like titanium and zinc oxide, wear a hat, and avoid tanning and sunburns.

Colon Cancer: Everyone over 50 should undergo tests to find polyps and cancer. For African-Americans, the recommended first screening is five years earlier, at age 45. Anyone with a family history of colorectal cancer should be screened 10 years before the age at which the close family member was diagnosed. But don’t put it off. Colorectal cancer is one of the deadliest cancers in the US. Dr. gregory P. fitzHarris, a Colorectal Surgeon with Sentara Surgery Specialists, said when colon cancer is found, it has usually been there for years. “When a tumor is discovered, that patient may have literally been sitting on colon cancer for up to 10 years. If a patient has waited that long, frankly, the odds are against him or her,” FitzHarris said. Most patients diagnosed with colorectal cancer have no symptoms at all. If patients wait for symptoms it could be too late. FitzHarris said Portsmouth, Western Tidewater, and Chesapeake have among the highest mortality rates from colorectal cancer in Virginia, well above the state average. About 90% of colon cancers are preventable, if people follow the screening guidelines.

Prostate Cancer: Men over 50 should talk to their doctor about their options for a prostate exam or a PSA test, which checks levels of prostate-specific antigen in the blood.

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No matter what type of cancer, when it comes to early detection, family history is important. It might be a good idea to get additional checks depending on what family history turns up – blood cancers, or cancers of the head and neck. Some cancers have genetic links and some have environmental ones. Talk to your family members about illnesses and see what you can track down. A few generations of history would be ideal. Don’t be afraid to ask. Just say you are trying to find out what kind of screenings you should be doing as you age. Sophia Mikac, RN, and Integrative Care Manager from Peninsula Cancer Institute, said the Institute offers genetic testing and counseling for anyone coping with a loved one fighting cancer and who also wants to assess their own risks. “Fear of the unknown is often the scariest part. We can help people map out their risk assessment,” she said. In the case of cancer, an ounce of early detection might be worth a pound of cure. For more information about screening guidelines, check the American Cancer Society webpage at http://www.cancer.org/Healthy/findcancerearly/index

Pariser Dermatology: http://pariserderm.com/ health_watch.htm Peninsula Cancer Institute: http://www.peninsulacancerinstitute.com/aboutpci.htm Sentara Surgery Specialists: http://www.sentara.com/HOSPITALSFACILITIES/ SENTARAMEDICALGROUP/SURGERY/Pages/sentarasurgeryspecialists.aspx

Coping with Cancer:

YOU are not alone

2010 Beyond Boobs group photo

t’s an emotional time, and patients need lots of support to maintain a positive attitude for the journey ahead. There are physical, financial, emotional and logistical issues to consider. What kind of treatment should I do? Where should I do it? Should I act now or wait? Who can take me to treatment? How will I work? What will my insurance cover? How will my family deal with this? That’s why support services for patients and their families are crucial in successfully dealing with chronic illnesses such as cancer. Many people are familiar with national cancer resources such as the American Cancer Society, Lance Armstrong’s LiveStrong foundation, and Relay for Life. Even for specific types of cancer such as breast cancer there are large national organizations such as the Susan G. Komen Foundation, Avon Walks, and the National Breast Cancer Foundation. Such groups provide fundraising and awareness raising, important components of supporting the community. General cancer-support groups can be helpful in talking about general topics like fear, coping with treatment, and navigating the health care system. But also talking to others about your specific fears and experiences with your type of cancer can be therapeutic. Why does it matter whether it’s a group that has what you have? Well, it can be less isolating, and you can get better information for your particular situation. There’s also increased bonding and trust. You are not just sharing information, but your feelings and the specifics of the disease may be especially relevant as well. For example, Beyond Boobs is an organization supporting pre-menopausal women diagnosed with breast cancer. It was started by Mary Beth gibson of Williamsburg, who was diagnosed in her early 40s. Her three sons were very young (ages 3, 6, 7), and she was the family breadwinner. “A lot of support groups were for women in their 60s and 70s. They just weren’t facing the same issues as I was. It’s an example of when an isolating situation becomes more isolating,” Gibson said.

p peeR suppoRt makes a positive diFFeRenCe By natalie Miller Moore

“once patients hear the word ‘cancer,’ they don’t hear anything else.” It’s a well-known adage in oncology, and there’s a reason for it. Many people’s first thought after being diagnosed with cancer is: Am I going to die?

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support » For younger women, many of the challenges of breast cancer are the same, but there are some additional challenges. Treatment can put them into instant menopause because of a decrease in estrogen. Many women see a marked decrease in their sex drive, which can affect their relationships and selfimage. Depending on their age and life stage, they may also need to address fertility issues. If they have not had children yet, they may be facing difficult choices about how treatment will affect their fertility. Some women decide to harvest their eggs, but in order to get a significant amount of eggs, that procedure involves fertility drugs that increase the amount of estrogen in the body which may stimulate the growth of breast cancer cells too. Gibson and partner Rene Bowditch started Beyond Boobs to help women in this position connect with others like them. Another example of specific support is Jerry Walton, a math teacher in Virginia Beach, who started his own support group for multiple myeloma because he found out there wasn’t one in this area. He’d been involved in learning more about the disease through an umbrella organization, the International Myeloma Fund (IMF). The IMF turned out to be a great resource for Jerry as he undertook the process of starting the Southeastern Virginia (SEVA) Multiple Myeloma group in August 2007. “They sent out a mailing for all the people within 50 miles of Virginia Beach with my name and contact info on it,” he said. “Now, we have a solid group of about 50 people on email, and people

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who come from as far away as Richmond, or two hours west of here.” Why would people drive two hours for a support group? Well, having a support group specific to your disease can offer some unique features. Walton explained that when people get diagnosed with myeloma, which is a blood cancer, they often think it’s the better known melanoma, a skin cancer. “So once they get over that, it’s time to learn about what they really have and get deeper into what the disease means,” he said. “We get myeloma experts as speakers from all over to call in and we learn about what’s new in the field, with genetic research or the latest results on treatments.” Shortly after his diagnosis in 2007, Walton picked up a brochure on multiple myeloma treatments and was dismayed to see that the information was sorely out of date and all of the listed treatments had been eclipsed by new methods. He flipped over the brochure and saw it had been published eight years before, in 1999. Cancer treatment protocols have changed significantly in the last few decades, and for a less common cancer like multiple myeloma, it’s important to stay current. Through conference calls, the SEVA group has been able to hear from experts from the Cleveland Clinic, the Mayo Clinic, and Duke University. “There’s so much to learn, and it’s a field that’s changing so rapidly,” Walton said. Walton said it’s not just access to experts, but also learning from each other that he values. “I got some advice once not to let the support group turn into just a way to fundraise, and it’s true. “We need to support each other and share our experiences, too.” Group members are still part of larger organizations, such as the Leukemia and Lymphoma Society and Relay for Life. There are many levels of participation, and it’s up to individuals to decide what works best for them. charlie Hill was diagnosed with prostate cancer in his late 50s, and it was important for him to have other men to discuss the issues of prostate cancer with. Unlike some other cancers, prostate cancer diagnoses don’t always lead to immediate treatment. There is an option to “watch and wait,” and there can be serious side effects to treatment, such as incontinence and sexual dysfunction. Hill wanted to gather all the information he could before he made such a life-changing decision. “I talked to oncologists, and internists and other health care professionals, and didn’t get a consensus on treatment. I got a lot of perspectives from talking to other patients on what they did. And they reinforced to me that prostate cancer isn’t like most other cancers, where there’s no mystery what to do,” Hill said. Even the choices of treatment were complicated, and Hill struggled to decide. “I wrestled with it up until the last moment. Should I do this? But I decided that I was going to go for broke and give myself the best chance of removing the cancer.” Hill eventually founded a group called the Hampton Roads

PHOTO COURTESY OF SEVA

about treatments, it was Prostate Health Forum a safe place to share to provide the inforemotions. mation and support She said her hushe lacked during his band was wonderful and experience. supportive, but her supSome people port group was where she have a negative view felt comfortable sharing of support groups or what was really bothering just don’t want to talk her. “I thought getting about cancer. Terrence The SeVA Multiple Myeloma support group meets to celebrate the holidays together the information was most Afer-Anderson, a at a luncheon in 2010. helpful, and then sharing member of a prostate personal fears without cancer group that worry about hurting someone,” she said. meets at Norfolk General, encourages people who are scared or “I think it’s important for people to be supportive and supskeptical to give it a try. “Give it a chance. When you are dealing ported,” she said. “Actually, my husband told my doctor that with something unprecedented in your life, it demands a wholly there ought to be a support group for husbands because there new perspective,” he said. is no one to talk to and the idea of losing your wife is prevalent Afer-Anderson said it was beneficial for him to hear other during that time.” men discuss their concerns. “The whole experience is anxiety Spousal support groups are harder to find, but there are producing, but you have to gather as much information as more options online than ever. Some groups, like Walton’s SEVA possible. What better source of information is there than people group, break off into patient and caregiver segments during their who’ve experienced it?” meetings. Besides Facebook groups for various kinds of cancer cynthia gilliam finds comfort in knowing that her supand different situations, like the wives of men with cancer or port group members truly have “been there” in dealing with parents of kids dealing with cancer, there are also online support issues related to oral, head, and neck cancer. Her support group, groups through Sentara.com and cancer.org. which meets at EVMS once a month, shares strategies to help CHKD also offers support groups for parents who are dealing one another get through the effects of surgery, chemotherapy, with many challenges as their children go through treatment. Puband radiation. lic Relations Manager greg Raver-lampman said “You just need “I find that no one was aware of this cancer until they got to get the parents together, and they know how to help each diagnosed with it. So, there are a lot of aftereffects from it, like other.” The benefits of support seem numerous as each person dental issues from bone and teeth deterioration. There really is deals with cancer, their own or that of their loved ones. so much baggage with this type of cancer. There are scars, eatMany hospital systems offer places for support groups to ing issues, dry mouth, and sensitivity,” Gilliam said. meet and additional resources, such as celebrating survivorship Although many people treat these types of cancers sucdays, or cancer information workshops. Virginia Oncology Associcessfully, it can take up to two years to have mouth function, ates offers workshops on a variety of topics, including humor and such as working taste buds, return. And even then, it may not healing, meditation, keeping fit, and journal writing. be a return to “normal.” “Some people can never eat the same way again,” Gilliam said. “Eating is a huge social issue, and it’s hard to have to change that part of your life. You have to have patient friends.” Gilliam read every book on cancer she could get after her LoCaL SUPPorT GroUP reSoUrCeS diagnosis in 2008, but she still found herself helped by having a support group. The group shares strategies like nutritional Beyond Boobs: http://www.beyondboobsinc.org/ recipes that are easy to eat or put in a blender, and their experiSoutheastern Va Multiple Myeloma Support Group: http://seva.myeloma.org/ Prostate Health Forum: http://hrprostatehealth.homestead.com/ ences using acupuncture to stimulate their salivary glands. Sentara (including prostate cancer and head and neck cancer groups): Gilliam’s group also works to raise awareness about head and http://sentara.force.com/ClassAndEventSearchPage AND neck cancers, reaching out to local dentists and letting people http://www.sentara.com/Services/Cancer/Documents/CancerSupportGroups.pdf know about their group. “I knew from family members having CHKD: http://chkd.org/Services/SupportGroups/ cancer that there was likely a group just for my kind of cancer. Virginia oncology associates: So I searched until I found it,” Gilliam said. http://www.virginiacancer.com/SupportGroupsResources.aspx eunice fenwick was diagnosed with breast cancer in on Facebook: search for “cancer support group” and search for the type you are looking for. 2002, and she said she really values the support she got from her local Williamsburg support group. Besides information Healthcare in Hampton Roads

NavIgaTINg CaNCeR CaRe: Reach Out for Help and Find Resources By Natalie Miller Moore

Believe it or not, there are people dealing with cancer who give up treatment for simple reasons. Perhaps they can’t get a ride to treatment or they can’t afford their medication co-pay. “Sometimes people are not as connected, and they have no energy to keep asking people they don’t know well to drive them. It can be a barrier, and it can be too much for someone who is overwhelmed,” said Yvonne Pike, Patient Navigator for Riverside’s Cancer Care Center. It can be the small things that derail people overwhelmed by cancer, and the emotion and logistics that come with that diagnosis.

Many Hampton Roads health care providers offer a team approach to cancer care that includes case managers and cancer care coordinators — or patient navigators — who guide patients and their families through the treatment process. The health care system is complicated, and even with all the advances we’ve made in cancer care, it’s still difficult to navigate diagnosis, treatment and insurance. Pat Thornton, a breast cancer navigator for Sentara, said the idea of patient navigation came from physicians in Harlem who saw their patients’ care fragmented and thought there needed to be someone to help streamline the process. Typically, patients meet with a navigator 24 hours after diagnosis. The navigator helps them assess the intense and often overwhelming amount of information they face.

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“I meet with her family and friends to discuss the information from the physician,” Thornton said. “Is it clear? Does she have a good understanding of the diagnosis? We review the pathology report and family history. I also find out what the experience has been of any loved ones with cancer, which can encourage or jade their perception.” Major hospital systems across the country offer cancer patient navigators and offer similar access to resources offered locally. During these meetings, navigators review the current standards of treatment, assess the patients’ coping skills, their education level, and how they are reacting to the news. The navigators can also offer resources for counseling and financial issues. Riverside Cancer Care Center houses many resources, including four Patient Navigators, in a program Pike started in 1995. She had been an oncology care manager at the hospital, and between admissions, she’d often hear from patients about challenges they were facing, things like transportation, getting appointments for lab tests, co-payments, and medication costs. “I had dreamed of being available to people between office visits or hospital visits because I saw that outpatient issues affected hospital visits. People facing lack of insurance, inadequate care or a lack of home care would speed up their need to come back to the hospital,” Pike said. Working closely with doctors and other hospital staff, navigators can help patients deal with the impact of surgery and plan for issues that will arise before and after surgery rather than treat them as crises. Riverside set up its system to assign patient navigators at the Cancer Center to be responsible for certain cancer specialties, and Pike started in breast cancer. Pike said that for a long time she didn’t see breast cancer patients as much in the hospital because they often had surgery and treatment as outpatients. “I figured they were floating out there, and I was right.” Riverside added a prostate Patient Navigator next. Then

paperwork and some of the logistics of the health care system such as co-pays, assistance programs and medication access. Margie Griffin, Senior Service Program Director and Senior Case Manager from PAF, said “There’s always the fear factor, and there’s so much information for patients. They want their doctor to think they are handling it OK, so they may not

PHOTO COURTeSY OF RIveRSIDe HeAlTH SYSTeM

they added a lung cancer navigator, who helps with an initiative called the virtual clinic, and a navigator for colorectal and digestive cancer. Pike estimates that 80% of cancers are covered by the current navigators, but she hopes more types of cancer will be covered eventually. “There are different flows for different types of cancers. And with cancer research constantly changing, there are many different aspects of care to manage, so it’s better to specialize,” she said. The navigator often attends biopsy result appointments, which is when the patient sits down with the doctor to discuss the results of the biopsy and find out if they have a benign or metastatic tumor. If it’s cancerous, the next steps for the navigator are to provide materials, identify barriers, set up appointments, and provide resources. The meeting can take up to two hours as the patient absorbs the news and the information. One of Pike’s patients, Sherry Rousselle, was diagnosed with breast cancer in 2007 and was glad to have a patient navigator to guide her. “Yvonne Pike is an incredible woman. She held my hand through it. The morning of the double mastectomy while they gave me nuclear medicine injections, they contacted someone to get me mastectomy supplies, and I felt supported by the team,” Rousselle said. “Throughout the process, everyone said, ‘No matter what, call us.” Pike said she finds her job extremely rewarding. “When someone comes to you with cancer, it changes their lives. It never happens at a good time, and you can help them.” She admits it can be intense. “You are not entering someone’s life when things are easy. People are anxious, and even for people who are fairly savvy, there can be critical times.” But, she said, the impact of having navigation through the health care system is clearly positive. “Not everyone needs the same amount of help, and the beginning is a critical time. Access seems to be a major component of navigation. Someone to be able to ask the small questions like “What should I wear for surgery?” and “Who can my family call to find out I’m out of surgery?” she said. Costs also have a huge impact on people diagnosed with cancer, and there is financial counseling available through hospitals and insurance companies. People are terrified that cancer will bankrupt them, and it’s not uncommon for patients to have a box of unopened mail they are scared to open for fear of growing medical bills. One independent organization that helps people navigate their insurance, or their lack of insurance, is the Patient Advocate Foundation (PAF), a non-profit organization based in Hampton. This free service serves the entire United States with a large call center of case managers to help people figure out their benefits,

Yvonne Pike, Patient Navigator for Riverside’s Cancer Care Center

NAvIGATING CANCER CARE say ‘I’m having trouble filling out this form’ or ‘I don’t know why I need to fill this out again.’ ” Unfortunately, a lot of people don’t read their health care plan until they are sick, and by then they have many more questions about how their plan applies to their new situation after diagnosis. “Even smart people may not understand some of the guidelines, and there are assumptions made about where help will come from – like their employer, Social Security, Medicaid. It can be complicated,” Griffin said. PAF helps with the myriad of details that plague people going through cancer treatment. Experienced case managers can help get letters of medical necessity and facility coverage from doctors to insurance companies, they can navigate guidelines that vary by state, and they know how to process referrals and pre-authorizations to get coverage. In a case study provided by PAF, a Newport News woman living with stage four colon cancer called PAF because her annual follow up PET scan had been denied twice by her insurance company as “not medically necessary.” The issue was resolved when a Patient Advocate Foundation case manager contacted the insurer to learn that the facility did not obtain approval before the PET scan. While pre-approval was not necessary, according to the plan’s language, it was recommended. The case manager submitted a first-level appeal on behalf of the patient, citing evidence that the PET scan was medically necessary. The claim denial was overturned. Besides dealing with health issues, the Patient Advocate Foundation also assists with job or financial issues, which can be intricately linked to a patient’s insurance situation. Tanya Walker, RN, BSN, Senior Clinical Case Manager said one of the things case managers specialize in is creative thinking. “People call us for one thing, but we help out with the rest as well. We ask about insurance, disability, COBRA, and FMLA. There may be underlying issues – age, income, family size — and it’s important to find out the whole situation,” she said. “I think we set ourselves apart with resources. You might have tunnel vision on one thing, but we can help deal with other things, too,” Walker said In another case study provided by PAF, a 54-year-old man with stage four lung cancer called because he was having trouble paying for his medications. It turned out to be a result of a delay of Social Security disability decision. The PAF case manager was able to help him expedite the claim by conducting a conference call to find out what was

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delaying the approval of his disability claim. It turned out that the disability determination examiner was waiting to receive the patient’s pathology report. Once this paperwork was delivered, the patient’s disability benefits were approved. Through the case management provided by PAF, he was able to resume cancer treatment — held up by just one piece of paperwork. Another important function of PAF is the publications it creates to help make information easier for patients to understand, such as “Your Guide to the Disability Process,” “The Managed Care Answer Guide,” and “Lighting the Way: A Practical Guide to Clinical Trials.” PAF also created the “National Underinsured Resource Directory” and “The National Financial Resources Guidebook for Patients: A State-by-State Directory (both available on their website). These include information for patients seeking financial relief for a broad range of needs, including housing, utilities, food, transportation, and children’s resources. For example, people traveling for cancer treatment may need discounted lodging and can be directed to organizations such as Joe’s House and the American Cancer Society’s Hope Lodges. Although the case managers at PAF are passionate about the work they do advocating for the patients that call them, they strive to help them empower themselves by providing resources rather than taking over and doing it for them. Pat Jolley, RN, Chief of Patient Services for PAF, has some advice for anyone dealing with life-changing health situations: “Be your own best advocate. At the end of the day, it’s your life, and your decisions. So ask questions and keep good records.” Oh, and don’t forget to ask for help! It’s out there, through local hospital systems and independent non-profit organizations—including the American Cancer Society which also has patient navigation services.

Sentara Patient Navigators: http://www.sentara.com/services/ cancer/pages/patient-navigators.aspx riverside: http://www.riversideonline.com/services/cancer/ Riverside: local-resources.cfm Patient advocate Advocate Foundation: www.Patientadvocate.org Joe’s House: www.joeshouse.org Hope Lodge: http://www.cancer.org/Treatment/ SupportProgramsServices/HopeLodge/index American Cancer Society: 1-800-ACS-2345 american

Care at Home Delivers Health care and Help By a.J. .J. Plunkett

There is no substitute for the comforts of familiar surroundings during the treatment of cancer. Instead of the busy, clinical environment of a hospital, patients can conserve energy and get what they need delivered at a time when they need individual support.

PHOTO COURTESY OF RIVERSIDE HEALTH SYSTEM

arilyn Rowland, 73, from Churchland, has been using home care through bon secours for the past year. she has been fighting lung cancer and previously was treated for throat cancer. the radiation to treat her throat cancer caused her throat to close, so she uses a feeding tube. Rowland also has a piCC line, a type of catheter that is remains in her arm, for her chemotherapy treatments. “i couldn’t be stuck (with a needle) all the time for chemo, so i need someone to change the dressing each week. i can’t do it myself, so it helps to have a nurse do it, and it’s better for her to come to me,” Rowland said. Rowland said home care is a convenience for her and having care at home never made her feel more “sick” or more “needy.” she said she’s been “optimistic through it all,” and she likes knowing she has a relationship with her nurse if she has any problems. Home health care is one of the fastest growing sectors of the health industry, according to the u.s. bureau of Labor statistics. it is expected to continue to grow as medical improvements push more care to outpatient facilities and allow treatments that were once the strict purview of a hospital or doctor’s office to be done at home. For instance, at least four of the major medical facilities in the Hampton Roads area – sentara, Riverside, Chesapeake Regional,

Care at Home

PHOTO COURTESY OF RIVERSIDE HEALTH SYSTEM

are other necessary services like and Bon Secours – tout the cleaning and laundry that need to ability of their home care be done. Owner ed golden said professionals to provide people of all ages being treated intravenous or infusion therapy for cancer often take advantage of that includes, among other those services while they conserve treatments, some types of their strength for the rigors of chemotherapy. treatment. Among other services, the “We meet with them, and four health systems also offer they let us know how their chemo specialists in pain management, is affecting them. As our clients’ dietary needs, physical needs change, we change right therapy, and social services. along with them,” Golden said. Improvements in technology For example, Golden said, allow some cancer patients making meals can be taxing for to receive their intravenous Martha Petit discusses options for obtaining a wig post-chemotherapy with a patient. cancer patients. Aides can discuss chemotherapy at home. The dietary needs, get groceries, make chemotherapy regimen for meals, and even freeze some for many patients can be daily for that patients should investigate their options. later. “We do a detailed interview to find out several weeks at a time, and this option makes it For instance, home care is commonly used for how we can help, and over time we know each more convenient for patients. And not traveling patients after surgery, and hospice care is for client’s likes and dislikes,” he said. to and from the hospital reduces patients’ end-of-life situations. In between, for patients These types of services at home can be exposure to germs. who need care at home for various reasons, invaluable to people who need to focus on Home care can include visits from there is palliative care, sometimes known as treating their cancer, rather than making dinner registered nurses, health aides, physical “bridge” care. For cancer patients, palliative care or making the bed. therapists, and social workers. Home care staff can assist with pain management, assess Organizations like the National Cancer agencies can assist with errands, meals, fatigue and dehydration, and provide additional Institute and the American Cancer Society medications, and personal hygiene. Agency resources as needed. recommend that anyone looking for home professionals can also educate family and friends Petit said palliative care “provides comfort health care be sure to coordinate it with the in their roles as caregivers, and offer respite for care and support, but the patient can still get patient’s medical team and take the time to them, particularly in long-term care situations. aggressive treatment. Having the support helps compare services and agencies. Private home care companies are also walk them through the briar patch so, hopefully, The National Cancer Institute notes that experiencing growth for the same reasons as they can continue treatment.” American Cancer Society chapters offer a variety local hospital systems. Shonda Washington One of the advantages of palliative care of services to cancer patients and their families. was a registered nurse in the Navy and stationed through a hospital system is that it makes for And chapters of the Red Cross and other social in Portsmouth when she launched a home easy communication with the oncology team. service organizations, including those affiliated health care business in Suffolk with the help of Caregivers can be the “eyes and ears” for the with churches and other non-profit groups, also her husband, another nurse, and a brother-indoctors back at the hospital. can provide help for patients. law. Petit said a doctor may recommend Her first few clients were cancer patients, palliative care for a cancer patient if, for example, many of whom were left weakened by he or she feels more debilitated since the last chemotherapy and other treatments. She and visit, has little family support, or is exhausted by her crew stepped in to perform everything from HoMe HeaLTH Care coming in to the office. basic nursing tasks like maintaining physical reSoUrCeS Other home care services, such as Sentara, therapy and clearing out catheters, to everyday stress the collaborative nature of palliative home activities such as helping patients bathe or dress, National Cancer Institute: www.cancer.gov/ care. For example, they can coordinate physical washing dishes, and doing laundry. cancertopics/factsheet/Support/home-care and occupational therapy, medical equipment, When she decided to operate a home American Cancer Society: www.cancer.org and communication with the doctor’s office. health care business, Washington said she not National Association for Home Care & Another type of home care service is only saw an opportunity, she recognized a need, Hospice: www.nahc.org/ a personal care agency, such as the Daytonsince hospitals are sending patients home faster. Virginia Department of Health: www.vdh. based franchise Comfort Keepers®, which Five years later, Accessible Home Health Care virginia.gov/OLC/AcuteCare/home_hospice.htm of Hampton Roads has grown almost tenfold, has local offices in the Williamsburg and A comparison of Medicare-certified said Washington, who, along with her husband, Newport News areas. Comfort Keepers does home health agencies is available on the retired from the military earlier this year. Medicare web site: not provide medical care. Rather it assists with www.medicare.gov/HomeHealthCompare/ Martha Petit, a Palliative Care Facilitator activities of daily living as well as housework, search.aspx for Riverside Health Systems, stresses that meal preparation, and transportation. They there are different types of home care and don’t provide in-home medical care, but there 18

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CLiniCaL tRiaLs:

A Legacy of science LoCaL patients HeLp ReseaRCHeRs studY new and impRoved tReatments By a.J. Plunkett

Jesse grace Hall, cancer patient at cHKD

esse grace Hall, looking lovely in a frilly pink dress, sat dutifully at the dining table in her parents’ Williamsburg home. But in less than a minute, she leaned against her mother and gave a pleading look to be released. Jesse Grace is 3 years old, and she had things to do. She’s already accomplished quite a bit. She has tons of friends and admirers, she can work an iPad better than many adults, and she’s helped with the advancement of medical science. Mostly, she’s a 25-pound, walking, talking – sometimes running and shrieking -- survivor of chemo- and radiation therapy to fight neuroblastoma, a cancer that most often strikes children under the age of 6. Last fall, when Jesse’s parents, Soosan and Mike Hall, heard from doctors at the Children’s Hospital of the King’s Daughters, in Norfolk, that it was cancer behind their daughter’s unrelenting fever, they reacted with shock and tears. “The next thing that takes over is, ‘We’re going to fight this,’” said Soosan Hall. And when doctors and nurses at CHKD began to talk with them about including Jesse Grace in clinical studies for neuroblastoma treatment, the decision was not hard, Hall said. She knew they had to fight not only for Jesse Grace, but for any other child that might face a future with the disease. Helping others is often the motivation for a patient to participate in a trial, said Dr. Paul R. conkling, a medical oncologist and hematologist with Virginia Oncology Associates, which sees patients at 10 locations throughout Hampton Roads. “This is how we do better for the next generation,” said Conkling, who, as Virginia Oncology’s research site leader, is overseeing about 50 active trials.

Healthcare in Hampton Roads

PHOTOS COURTESY OF CHKD

“We stand on the shoulders of those who went before us,” said Dr. Scott Williams, a professor of radiation oncology and researcher at Eastern Virginia Medical School who also practices at Sentara Norfolk General Hospital. Hampton Roads-area oncology groups, cancer centers, and hospitals are participating in more than 120 active clinical trials within a 50-mile radius of Norfolk, according to the National Cancer Institute, an arm of the National Institutes of Health. Clinical cancer trials can include testing the latest new drug or surgical breakthrough. But most often they are refining drugs – or combinations of drugs – and radiological and surgical treatments that already exist. Trials may also look at treatment side effects, cancer prevention, and ways to diagnosis different cancers. Trials are done in stages, or phases, and have strict oversight from the Food and Drug Administration, using an institutional review board that includes health care and community professionals, such as social workers or patient advocates. These review board members work together to ensure that the “rights, safety and well-being of trial participants will be protected,” according to the NIH. The first phase of a trial has few patients and is designed to study safety first, and then to determine the optimal range of dosage of drugs or radiation. In the second phase, the trial is expanded to include both safety and effectiveness of the new treatment. Once a treatment has shown some effectiveness, it can move into the third phase, which uses large groups of patients and Jesse grace in yard at home compares the new treatment against the current standard of care. A computer divides patients into the two groups at random. Throughout the process, physicians overseeing the trials at a local level track patients’ progress, reporting results to the researchers sponsoring the trial. Often the physicians gather in person or via teleconferences to talk about ongoing developments. 20

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While the common perception of research is that one person gets a new drug while another gets a placebo, with cancer trials the comparison is the standard care versus the new care, said Dr. guy W. Tillinghast, principal investigator overseeing trials at Riverside Health Systems’ Peninsula Cancer Center. At no time is a patient not getting at least – with an emphasis on “at least” – the current standard of care for his or her particular cancer. ora Mae Jackson, the oncology nurse who heads up clinical research management at the center, is often the first person patients talk to after they have been identified by their physician as eligible for a trial. It’s her job to give patients the facts about clinical trials, both the pros and the cons, and to gain their “informed consent,” a process she said continues throughout the trial, as the treatment or the patient’s condition changes. Patients must fully understand the downside of participating in a trial. Any treatment can have side effects, and they can be potentially severe, even fatal. Sometimes a treatment shows so little effectiveness or such consistently severe side effects that the trial is closed early. But some trials prove so successful that all of the patients enrolled in the trial can end up getting the new treatment. Sometimes, it becomes clear that the new treatment is so much better than the old that “it becomes unethical not to give it to all patients,” Tillinghast said. That was the case involving ipilimumab, a drug researchers hoped would become the first to help in the fight against advanced melanoma, or skin cancer. Patients with advanced melanoma often have months or sometimes just weeks to live. About 30 patients from Virginia and North Carolina went through review by the Peninsula Cancer Center to participate in the ipilimumab trial. Among other criteria, a patient’s cancer had to have failed to respond to earlier treatment, Jackson said. Some patients were referred by their doctors, while others learned of the trial and called the center. Not every patient met all the criteria to participate. While some clinical trials take years from start to finish, the trial for ipilimumab showed improved survival rates almost immediately. All test patients began to get the drug, and the FDA agreed to fast-track its review. Six months later, in March 2011, the drug received FDA approval under the brand name Yervoy® (ipilimumab.) Dr. Kim Schlesinger, an oncologist with Riverside, said that although Yervoy was just approved, her melanoma patients in Hampton Roads have been able to take advantage of it via clinical trials. “It’s exciting to have more options, and this seems to be the year of melanoma with new drugs getting approved,”she said. But, noting that Riverside is a clinical trial,“We’ve had it for some time and are comfortable using it.” But many success stories are not as dramatic. Sometimes the success of a trial is refining an existing

CLiniCaL tRiaLs treatment to both improve the patient’s outcome and lessen the side effects, said Williams. For example, Williams has patients at Sentara who are part of a prostate cancer study in which the number of radiation treatments are reduced from 41 doses, the current standard of care, to 28 doses. The new treatment targets the radiation more precisely over a shorter time, he said. Some of the most successful trials are not necessarily testing anything new, said Dr. eric J. lowe. He is an oncologist at Children’s Hospital of the King’s Daughters, where he oversees the 50 or so clinical trials currently open at the Norfolk facility. Jesse Grace is among his patients. Pediatric cancer is rare. Of the 1.5 million people diagnosed with cancer every year in the United States, only about 1 percent are children, Lowe said. But while the participation rate in clinical trials among adults is only about 5 percent, almost 70 percent of pediatric patients are enrolled in studies. Parents, and sometimes the children themselves, are eager to help find better treatments and methods, perhaps for others, if not themselves. And sometimes, the something better is already in front of you, but you just have to find the right combination, Lowe said. He points to acute lymphoblastic leukemia, the most common of childhood cancers. In the 1960s, only about 5 percent of acute lymphoblastic leukemia patients survived, he said. Today, the survival rate is up to 85 percent. The current treatment isn’t a new drug. Rather it was a matter of figuring out how to use existing drugs in combination, in what order and when, he said. “All of those answers were found in clinical trials,” Lowe said. Soosan Hall is a believer in clinical trials. By the time doctors found the cancer that attacked her daughter’s nervous system, the resulting tumor had grown from little Jesse Grace’s spinal cord, wrapped itself around her aorta, around the veins that feed blood from the upper body back to the heart, and her abdomen to encase the femoral arteries that feed blood to the legs. After consulting with several doctors, her parents decided the best plan of action was chemotherapy, then radiation. The first step was implanting a tube in Jesse Grace’s chest to deliver chemo. Then little Jesse Grace was hooked up for one to two hours to an IV bag on a pole that the Halls nicknamed “Fred.” CHKD’s cancer floor has a central treatment room, where children undergoing chemotherapy can watch television, read, or play games with family or each other. The playroom feels so much like happy place that Jesse would get excited to go for her treatments, her mother said. There was the pain and nausea and hair loss typical of the chemotherapy treatments, but Jesse bounced back quickly each time, her mother said. Of the many drugs used in the chemotherapy – six treatments, with a final seventh megadose – one in particular, cisplatin, is known to cause hearing loss in children, Lowe said.

The Halls were approached about enrolling Jesse in a trial to test whether doses of sodium thiosulfate would protect patients from hearing loss. Some patients would get the compound, others would not, through the randomized selection process of the trial. They immediately said yes. “We lucked out and randomized into getting the sodium thiosulfate,” Hall said. Jesse’s hearing survived the treatment, as evidenced by several of her responses from another room when her mother called to her from the dining table. Soosan Hall said she later learned that another patient, who the family met through Jesse’s treatments at CHKD, was also part of the study and was not so lucky. The child lost hearing. “We were lucky,” she repeated, somberly. While that clinical trial seemed to benefit young Jesse Grace, it is unclear what will be the results of another trial she is participating in. There is a trial for neuroblastoma patients who have finished standard treatment, in which some patients are given a chimeric antibody, which binds to any remaining neuroblastoma cells and marks them for the body’s own immune system to attack if they begin to grow again. A patient has to be admitted to intensive care during each of the five treatments – treatments that last 10 hours a day, for four days each time – so that the severe potential side effects can be managed. While the side effects can be severe, the upside is that the trial already has shown that the treatment improves patients’ survival by 15 to 20 percent, and the chimeric antibody is now part of the standard of care, said Lowe. Jesse Grace is the fourth child to get the antibody at CHKD, Soosan Hall said. Despite the risks, participating in the clinical trials was something they had to do, she said. It helped save Jesse’s hearing, and the chimeric antibody could help save her life --and someone else’s child, as well. “I try to ask God every day for more time, because it’s ultimately his decision. But if, God forbid, she does die, but she could help someone else, then it’s worth it,” Hall said. The oncology community of Hampton Roads continues to advance science by participating in clinical trials and allowing local residents access to cutting edge care. If you are interested in participating in a clinical trial for cancer, speak to your doctor about your options.

For more information about clinical trials, how they work and who may benefit from them, you can find details on the National Cancer Institute’s web site at www.cancer.gov, or speak with your physician. The site also has a searchable database of trials that can be sorted according to specific cancer or location.

Healthcare in Hampton Roads

» cancer Programs in Hampton Roads offer a Variety of Distinctions

PHOTO COURTESY OF SENTARA HEALTHCARE

By a.J. Plunkett

The American college of Surgeons’ commission on cancer has a searchable database of cancer programs it has accredited across the nation, in varying categories. The program involves a voluntary application from each hospital, which is then rated according to its compliance with 36 standards. A search of the AcS database for local hospitals shows accreditation in four categories: national cancer Program – The organization owns multiple facilities providing integrated cancer care and comprehensive services, and participates in clinical research. Teaching Hospital cancer Program – The facility is connected with a medical school, and offers a full range of diagnostic and treatment services, either on site or by referral, and participates in clinical research. community Hospital comprehensive cancer Program – The facility handles 650 or more newly diagnosed cancer cases each year, offers a full range of

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diagnostic and treatment services, either on site or by referral, and participates in clinical research. The medical staff is board certified in major specialties, including oncology where available. community Hospital cancer Program – The facility handles 100 to 649 newly diagnosed cancer cases each year, offers a full range of diagnostic and treatment services, but referral for a portion of treatment is common. The medical staff is board certified in major specialties. The facility may participate in clinical research.

In alphabetical order, hospital groups in Hampton Roads carried the following ACS program designations: Bon secours – Both the DePaul Medical Center and Maryview Medical Center, which both have cancer centers, are accredited under the Community Hospital Cancer Program. Their specialties include minimally invasive colorectal surgery and a cancer care gynecology program that treats patients from five states, as well as comprehensive treatments for lung, chest, colorectal, breast, ovarian and prostate cancers. chesapeake regional Medical center – The Sidney M. Oman Cancer Center is accredited under the Community Hospital Comprehensive Cancer Program. The center offers a low-dose rateseed implantation in the radiological treatment of prostate cancer, as well as a breast center that offers stateof-the-art cancer diagnostics and treatments and a neuro-oncology team that specializes in the surgical treatment of malignant brain tumors. The hospital’s neurological and neurosurgical care was recently recognized in U.S. News and World Report. riverside Health system – Riverside Regional Medical Center, where Riverside’s Peninsula Cancer Center is located, is accredited as a Community Hospital Comprehensive Cancer Program. Riverside’s Walter Reed Hospital in Gloucester is accredited as a Community Hospital Cancer Program. Its Cancer Center’s

specialties include a radiosurgery center that offers non-invasive Gamma Knife surgery for brain tumors, infusion therapy, and specialists in breast, colon and prostate cancers. sentara Healthcare system – Sentara is the only local health care group accredited as a Network Cancer Program. Sentara Careplex in Hampton, Sentara Leigh in Norfolk, and Sentara Virginia Beach are accredited as Community Hospital Comprehensive Programs, while Sentara Williamsburg is accredited as a Community Hospital Cancer Program, and Sentara Norfolk

General is accredited as a Teaching Hospital Cancer Program. The group’s specialties include a variety of surgical and radiation therapies designed to be minimally invasive. While not listed under the voluntary ACS accreditation programs, the children’s Hospital of the King’s daughters is the chief pediatric cancer treatment center in Hampton Roads. It has a Golden Seal of Approval from the Joint Commission, one of the highest marks given by the non-profit organization, which accredits more than 19,000 health care programs nationwide.

independent. it’s not by chance. it’s by choice.

On its website, the National Cancer Institute refers patients looking for treatment centers to both the American College of Surgeons and the Joint Commission for listings of accredited programs. To learn more online, go to: National Cancer Institute: www.cancer.gov The american College of Surgeons: www.facs.org/cancer/ The Joint Commission: www.jointcommission. org/ and select the ‘Accreditation’ tab.

Over the last 35 years, we’ve had more than a few opportunities to join with major healthcare networks. We’ve never done it. Our independence allows us to make our policy and spending decisions locally, investing in our community, responding to what our community medical needs are in a more personalized way.

Call or visit us online today and learn more. 757-312-8121 | www.Chesapeakeregional.Com 736 Battlefield Blvd. north, Chesapeake, Va 23320

Healthcare in Hampton Roads

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paCe is uniQue. it is an optionaL beneFit undeR botH mediCaRe and mediCaid that focuses entirely on older people, who are frail enough to meet their state’s standards for nursing home care. it features comprehensive medical and social services that can be provided at an adult day health center, home, and/or inpatient facilities. For most patients, the comprehensive service package permits them to continue living at home while receiving services, rather than be institutionalized. a team of doctors, nurses and other health professionals assess participant needs, develop care plans, and deliver all services which are integrated into a complete health care plan. paCe is available only in states which have chosen to offer paCe under medicaid.

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eligibility Eligible individuals who wish to participate must voluntarily enroll. PACE enrollees also must: • Be at least 55 years of age. • Live in the PACE service area. • Be screened by a team of doctors, nurses, and other health professionals as meeting that state’s nursing facility level of care. • At the time of enrollment, be able to safely live in a community setting.

services PACE offers and manages all of the medical, social and rehabilitative services their enrollees need to preserve or restore their independence, to remain in their homes and communities, and to maintain their quality of life. The PACE service package must include all Medicare and Medicaid services provided by that State. In addition, the PACE organization provides any service determined necessary by the interdisciplinary team. Minimum services that must be provided in the PACE center include primary care services, social services, restorative therapies, personal care and supportive services, nutritional counseling, recreational therapy, and meals. Services are available 24 hours a day, 7 days a week, 365 days a year. Generally, these services are provided in an adult day health center setting, but may also include in-home and other referral services that enrollees may need. This includes such services as medical specialists, laboratory and other diagnostic services, hospital and nursing home care. An enrollee’s need is determined by PACE’s medical team of care providers. PACE teams include the following: • All Medicaid covered services, as required in the State’s approved Medicaid State Plan. • Primary medical and specialty care; which includes Anesthesiology, audiology, cardiology, dentistry, dermatology,

senioR LivinG gastroenterology, gynecology, internal medicine, nephrology, oncology, ophthalmology, oral surgery, orthopedic surgery, otorhinolaryngology, pharmacy consulting services, podiatry, psychiatry, pulmonary disease, radiology, rheumatology, general surgery, thoracic and vascular surgery and urology • Nursing • Social Work • Personal care • In-home supportive services • Restorative therapies: Occupational, Physical and Speechlanguage-pathology • Meals and nutritional care • Transportation • Recreational therapy • Hospitalization • Nursing facility care • Prescription Drugs • Laboratory tests, X-rays and other diagnostic procedures • Prosthetics, orthotics, durable medical equipment, corrective vision devices, such as eyeglasses and lenses, hearing aids, dentures, and repair and maintenance items

Pace interdisciplinary Team All PACE organizations utilize the professional expertise of an interdisciplinary team (IDT) to provide case management on all services provided to and arranged by the PACE program for each enrolled PACE participant. As required in both federal and state regulations, the PACE organization’s IDT is comprised of the following members who have a minimum of one year’s experience working with the frail elderly population: • Primary Care Physician • Registered Nurse • Nurse Practitioner (Optional) • Masters Level Social Worker • Physical Therapist • Occupational Therapist • Dietitian • Recreational Therapist or Activity Coordinator • Home Care Coordinator • Personal Care Attendant • PACE Site Manager • Transportation - Van Driver The PACE team has frequent contact with their enrollees. This helps them to detect subtle changes in their enrollee’s condition and they can react quickly to changing medical, functional, and psychosocial problems.

Hampton roads Pace Programs SenTARA Sentara Senior community care (SScc), Virginia Beach, Virginia On November 1, 2007, Virginia celebrated the opening of its first PACE program. On June 24, 2008, the Department of Medical Assistance Services (DMAS), Division of Long-Term Care (LTC), approved the application submitted by Sentara Life Care Corporation to develop The Program of All-Inclusive Care for the Elderly (PACE) in the Cities of Portsmouth, Chesapeake, Norfolk and Suffolk. http://www.sentara.com/Services/Seniors/Pages/SeniorServices.aspx http://www.sentara.com

RIVeRSIDe On February 1, 2008, Virginia opened its second PACE program in Hampton, Virginia. Riverside at the Peninsula will provide services to frail older citizens living in areas of Hampton, Newport News, Poquoson and the southeastern portion of York County. http://www.riversideonline.com/pace/index.cfm http://www.riversideonline.com

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I’VE BEEN

…of suggesting a more active life ( daily walks, strength training, so, before i jump into this article i will clearly state:

“A MORE ACTIVE LIFESTYLE IS noT I just haven’t found the exception yet.

or many years research has proven that calorie-burning exercise obviously reduces obesity, heart disease and its relatives-stroke, high blood pressure& and high cholesterol, also the incidences of diabetes, depression, Alzheimer’s, etc. Just when it seemed the list couldn’t get much longer, a major addition: CANCER ! Yep, exercise and the prevention of certain CANCERS are clearly linked. And the evidence showing the connection between exercise and improved recovery is just as certain. This is not opinion or wishful thinking. Most of the research cited here is from the Journal of the American Medical Association, Harvard Medical School and the American Cancer Society. “Physical activity is central to reducing your risk of cancer,” says Dr. Michael Thun, vice president emeritus at the American Cancer Society. Specifically: at least 30 minutes of moderateto-vigorous physical activity at least 5 days per week but preferably 45 to 60 minutes. Let’s call “moderate” activity when your heart and breathing rate increase but you can still have a conversation. In contrast, “vigorous” is when you’re working, sweating and not comfortably talking. According to a report delivered to the European Cancer Organization and the European Society for Medical Oncology, being fat may become the leading cause of cancer as soon as 2020. Research also shows that colorectal, breast, endometrial, stomach, intestinal and esophageal are the most likely cancers to be directly affected by the increased body fat and resulting hormone production. Current data indicates as many as 1 in 2 men and 1 in 3 women will receive a cancer diagnosis in their lifetime. Our often maligned

“Physical activity is central to reducing your risk of cancer.”

nutRition and weLLness

ACCUSED…

increased joint range of motion, etc.) is a cure for everything.

A CURE FOR EVERYTHING.” By Brian cole

medical community is doing a much better job following that dreaded diagnosis. Survival and recovery rates are soaring. The hard fact is cancer can be a real opportunity to adopt behaviors proven to improve the quality and longevity of our brief stay here. First, is it safe to exercise during recovery? Traditionally exercise programs were recommended after surgery, chemotherapy or radiation. However many current studies are finding that exercise during treatment can enhance the immune system and the ability to function physically and emotionally. The following are common symptoms and side effects experienced during treatment: cardiopulmonary weakness, depressed mood, fatigue, immune system suppression, muscle weakness and imbalances, nausea, reduced bone mineral density and loss of lean muscle tissue. All of these are directly affected by an appropriate exercise program. This is obviously a decision to be made by the oncologist but we all must take responsibility for our health. Knowledge of current research is one step toward informed discussions with our medical professionals. And now, what type of exercise is best for survivors? There is not one form of exercise appropriate for all types of cancer survivors. Certain exercises, for instance, can make a common side effect of radiation (lymphedema) worse. General advice is much like that given to us all: cardiovascular walking, strength training (moderate following recovery), improve joint range of motion thru yoga and other gentle movement modalities. The intensity level will probably be more like a previously sedentary person but will improve with consistency. The realization that we have some control over what we are faced with is impossible to overrate. If you or someone you know (and that’s the case for most of us) is dealing with

cancer treatment and recovery, please encourage them to stay up to date on the advantages of using this as an opportunity to take charge of their lives. There is a lot of evidence that says our actions and attitudes can have a profound effect on facing this challenge.

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Healthcare in Hampton Roads

Caring For You When You Need Us Most.

he specialists at Orthopaedic & Spine Center work in partnership with area oncologists to surgically treat patients with benign or malignant musculoskeletal tumors. The goal for our patients is to maintain or restore function through advanced and innovative surgical techniques. We also offer comprehensive rehabilitation in our Physical Therapy Department for those recovering from a tumor/ cancer-related musculoskeletal surgery. From our state-of-the-art orthopaedic facility to our caring staff, OSC is committed to providing exceptional patient care, every day. It is what we do.

Our Orthopaedic Team

Top 50 Orthopedic Practices to Know Jeffrey R. Carlson, M.D Boyd W. Haynes lll, M.D. Robert J. Snyder, M.D.

Martin R. Coleman, M.D. Mark W. McFarland, DO

Learn more about our full range of orthopaedic services at

www.osc-ortho.com

To read more about Beckerâ&#x20AC;&#x2122;s Review and OSC, scan the QR code to the right (using your smartphone) to be directed to the website. Proudly Accepting Tri-Care! Open MRI Center 250 Nat Turner Blvd. â&#x20AC;˘ Newport News, VA 23606 1-877-202-9130

Medical Oncology & Hematology Thomas A. Alberico, MD Burton F. Alexander, III, MD Daniel M. Atienza, MD Bruce W. Booth, MD Celeste T. Bremer, MD David Z. Chang, MD, PhD, FACP Paul R. Conkling, MD Scott J. Cross, MD Snehal A. Damle, MD Michael A. Danso, MD Mark T. Fleming, MD Edward R. George, MD, FACP Ranjit K. Goudar, MD Elizabeth A. Harden, MD, FACP John R. Howard, Jr., DO John F. Kessler, MD, FACP Boon C. Kok, MD Scott Kruger, MD, FACP Michael E. Lee, MD John Q. A. Mattern, II, DO Dean S. McGaughey, III, MD J. Christopher Paschold, MD, FACP David M. Powell, MD Christina W. Prillaman, MD, FACP Gauri V. Radkar, DO Ronald J. Ruszkowski, MD S. George Saman, MD Michael S. Steinberg, MD, PhD, FACP Alexander K. Su, MD Valiant D. Tan, MD

Gynecologic Oncology Michael E. McCollum, MD, FACOG Stacey J. Rogers, MD, FACOG Robert C. Squatrito, MD, FACOG

Radiation Oncology

Having touched the lives of cancer patients for over 30 years, we are committed to making a difference

in Hampton Roads and Northeast North Carolina.

Victor Archie, MD, MBA Heather Jones, MD, PhD Song K. Kang, MD Michael L. Miller, DO

HOPE FOR A CANCER-FREE TOMORROW. With 37 practicing physicians serving patients at more than 12 community locations, Virginia Oncology Associates is the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders. Together with The US Oncology Network, we are united in the fight against cancer. We combine the knowledge and resources of America’s largest cancer fighting network with expert cancer treatment and cutting edge research right here in our community. WORLD-CLASS CARE YOU NEED, RIGHT HERE CLOSE TO HOME.

Advanced Cancer Care • Multi-Disciplinary Cancer Center • Gynecologic Oncology • Medical Oncology • Evidence Based Medicine • Radiation Therapy • IGRT, IMRT, Brachytherapy • Hematology • Clinical Trials & Research • Laboratory Services • Stem Cell Transplantation • Translational Oncology Program • Nuclear Medicine

Sophisticated Patient Care

www.VirginiaCancer.com

• • • • • •

Patient Beneﬁts Specialists Genetics Counselor Nutritionist Licensed Clinical Social Worker Survivorship Program Educational/Community Resources

Scott S. Williams, MD, PhD Radiation Oncologist and Medical Director Sentara Advanced Radiosurgery Center Eastern Virginia Medical School Professor and Physician

CyberKnife.

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yberKnife and other sophisticated options are right here in the Sentara Cancer Network – so you don’t have to travel to receive advanced cancer care. CyberKnife, which sounds like a surgical procedure, is actually a painless and non-invasive form of radiation that offers accurate, effective treatment for tumors anywhere in the body – even in places previously considered unreachable. CyberKnife can shorten treatment time, replace surgery, and most importantly, extend hope to fight various types of cancer. At the Sentara Advanced Radiosurgery Center, a team of specialized physicians plans the care of each patient. This collaborative and personalized approach to patient care is one of the factors that established the Sentara Cancer Network as Virginia’s only accredited network program – a distinction from the American College of Surgeons’ Commission on Cancer.

Watch Dr. Williams and other physicians present a CyberKnife treatment.

To find out if CyberKnife treatment may be right for you, call the program coordinator directly at 757-388-2061. Sentara Advanced Radiosurgery Center at Sentara Norfolk General Hospital. sentara.com/radiosurgery

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