Banner MD Anderson Creating Hope by LOCALiQ

creating hope Prevention • Research • Innovation

JUNE 2013

Blessings in disguise A father on the move finds hope at Banner MD Anderson Cancer CenteR

By Jake Poinier

t was Mother’s Day 2012 when retired

U.S. Postal Service worker Michael Kilfoyle and his wife Donna purchased a home in Arizona. As they planned their post-work life, they made several trips over the summer between their Colorado home and their new abode. During one of them, Michael had difficulty urinating, which he attributed to dehydration in the August desert climate. Farshid Dayyani, M.D., with patient Michael Kilfoyle.

Get physical with cancer prevention

Knowledge is power

INSIDE THIS ISSUE

Eating Healthy

Skin Cancer Patient’s Survival

Events

As a precaution, he paid a visit to his family doctor — only to discover he had elevated prostate-specific antigen (PSA) levels. A subsequent biopsy found not only adenocarcinoma (the most common form of prostate cancer), but also a far less common type called small cell prostate cancer, which isn’t detectable by a PSA test. Radiation treatments and chemotherapy started immediately.

Doing the right things “I’d never smoked and seldom drank, so I thought I was doing all the right things,” Kilfoyle says. “But to have it come about as it did, finding the small cell cancer that spreads quickly, was a blessing in disguise.” A second blessing came in the form of their move to Arizona in December — within driving distance of the team at Banner MD Anderson Cancer Center in Gilbert. “When I saw Michael, he was in the 10 to 15 percent of patients whose cancer had already spread to other organs,” says medical oncologist Farshid Dayyani, M.D., Ph.D. “In those cases, you don’t do surgery or radiation, you start with hormonal treatments to reduce testosterone, which acts as fuel for cancer. Unfortunately, the aggressive ones become resistant, producing their own testosterone or using other hormones, and you have to treat the patient with chemotherapy. Fortunately, after four courses of chemo, he had a good response, and all the visible cancers shrank.”

Our multidisciplinary team, with radiation oncologists, urologists, and medical oncologists working together with the patient, helps us find the best approach. Farshid Dayyani, M.D. Happy Father’s Day As Father’s Day 2013 approaches, Kilfoyle’s most recent CT and bone scans indicate progress against the disease. “Donna and I have only been married three years, and it has brought us closer,” he says. “And we have family all over, including grandkids here in Arizona as well as in Colorado, and they’re always checking in on how I’m doing.” Backed by research and cutting-edge treatments, Banner MD Anderson Cancer Center physicians continue to make progress on finding and targeting the pathways in cancer cells that allow them to grow. “Our understanding of the biology of the disease has enabled us to develop novel targeted therapies,” Dayyani says. “In addition, our multidisciplinary team, with radiation oncologists, urologists, and medical oncologists working together with the patient, helps us find the best approach.” •ch

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Ask the expert

Mark I. Gimbel, M.D., is a surgical oncologist with Banner MD Anderson Cancer Center in Gilbert

I know I need to wear sunscreen when outdoors, but what should I look for in a product?

The options are so plentiful that choosing a sunscreen can be confusing. What you do want is a sunscreen with an SPF, or sun protection factor — that’s the percentage of ultraviolet-B (UVB) rays that will be prevented from penetrating the top layer of the skin, thereby causing a sunburn of at least 30. Make sure it’s also labeled as a “broad spectrum” sunscreen. That indicates it also protects the skin from UVA rays, the other kind of solar radiation. Because they penetrate deeper into the skin, UVA rays tend to cause aging effects, like wrinkles, and boost the rate of melanoma. Although they are messy and difficult to rub into the skin, sunblock products with zinc oxide or titanium dioxide are safe alternatives that work very well, diffracting 100 percent of ultraviolet rays. Just remember, even when using a broadspectrum sunblock or a sunscreen with an SPF of at least 30, you need to use it correctly by applying to all exposed skin about a half hour before venturing outside. Then, make sure you reapply it every two hours. If you’re sweating a lot or swimming, you may need to apply it more frequently. Limiting your sun exposure is also important, and, of course, never use a tanning bed. There’s no clinical need for them, and the increased risk of melanoma for women has increased tenfold in the past several years due to their use.

Look for broad spectrum sunscreens with an SPF of at least 30.

Get physical with cancer prevention

Prevention

Regular exercise can help reduce risk and ease stress

By Debra Gelbart

s with most things, there is good news and bad news when it comes to risk factors for cancer. The unsettling news is that some cancers may develop or grow in part because a person is overweight or obese. The better news is that being physically active can reduce your risk of getting cancer, regardless of what you weigh. So, exercise has become a vital part of the medical community’s arsenal against cancer. That message is key for Diljeet Singh, M.D., DrPH with Banner MD Anderson Cancer Center’s integrative medicine and cancer prevention program in Gilbert. In addition to improving breathing and muscle function and conditioning the heart, she points out, a couple of other critically important mechanisms are at work when we exercise. We’re telegraphing our endocrine and nervous systems to reduce production of the stress hormones that affect us negatively. At the same time, exercise boosts the hormones and other chemicals that are healthier for the body.

Weight factors It’s important to keep in mind that excess weight and lack of physical activity may increase levels of insulin and insulin growth factor (IGF). High levels of IGF and its sister, IGF-1, are not good for an adult body. IGF-1, a growth hormone that resembles insulin but differs slightly in its molecular structure, promotes the growth of normal tissue, especially in children, but it also can promote the growth of abnormal tissue (i.e. cancer cells) in adults. Here’s the good news: regular moderate exercise has been shown to reduce the body’s circulating levels of IGF-1. Researchers know that stress is linked to development of cancer.

“We’re starting to learn the role our sympathetic nervous system might play in the growth of cancer,” Singh says. In a busy, tension-filled world, she explained, “a nearly constant ‘fight or flight’ response to stress increases production of a number of what we

We’re starting to learn the role our sympathetic nervous system might play in the growth of cancer. Diljeet Singh, M.D., DrPH, Banner MD Anderson Cancer Center’s Integrative Medicine and Cancer Prevention Program call ‘stress modifiers.’” These include the steroid hormone cortisol, which increases blood sugar and suppresses the immune system; adrenaline, a hormone that increases heart rate and blood pressure; and norepinephrine, similar to adrenaline. If these hormones are always in overdrive, Singh says, they can fuel the growth of abnormal or mutated cells, the precursors to cancer. “Physical activity seems to modify the activity of these stress chemicals,” she says, and instead, it increases production of endorphins, the body’s “feel-good” chemicals. Exercise can help you manage not only your stress, but your body weight as well. “Exercise also helps you sleep better,” Singh says, “and greater muscle mass makes you crave more protein and other healthy foods.” In addition, she said, people who exercise often stay better hydrated.

Just 30 minutes a day What is often intimidating about exercise is the mistaken belief that you have to do a lot of it to enjoy the benefits. “All you need is about 150 minutes of moderate-intensity activity every week,” Singh says, emphasizing that 150 minutes translates into 30 minutes five times a week. “Thirty minutes of exercise a day can really help with stress management.” Best of all, you don’t need fancy equipment or a gym membership to exercise. “All you need to do is walk,” Singh says. An optimal workout would be walking “for up to 10 minutes at a time fast enough that you would have trouble chatting,” she says. After 10 minutes or so, slow down and walk at a more moderate pace for about five minutes. Then, repeat the cycle. “But even walking at a moderate pace for 30 minutes can be very beneficial.” •ch BannerMDAnderson.com

Feature

Knowledge is power Suspicion of Cancer Clinic gives patients hope, answers By Kristine Burnett

ometimes, not knowing is the hardest part. For 55-year-old Carl Stanley, an East Valley resident who began experiencing heavier than normal bleeding after undergoing dental work in October, the search for answers led him to the Suspicion of Cancer Clinic at Banner MD Anderson Cancer Center in Gilbert.

“My doctor ran some blood tests to try and figure out why I kept bleeding, and that’s when we discovered that my platelets were low,” Stanley says. “I was referred to Banner MD Anderson in February and saw Dr. Doshi on my first visit.”

Determining a cause Division chief of Internal Medicine at Banner MD Anderson, Nikunj Doshi, D.O., heads up the center’s multidisciplinary Suspicion of Cancer Clinic. Guided by the belief that knowledge is power, he serves as a sort of screening specialist investigating and confirming whether cancer is the cause of a patient’s unexplained health issue or abnormality. Those seen at the clinic include patients whose primary care physicians feel there is just cause for concern based on a physical exam or lab results. Patients may also self-refer to the clinic for worries about things like unexplained weight loss, lumps in their arms or chest, and more. “If the initial workup shows there is in fact a malignancy, the patient is referred to one of our specialists,” Doshi explained. “If cancer cannot be confirmed, we’ll follow the patient for a period of time to keep a watchful eye.”

Team with a plan Nikunj Doshi, D.O. division chief of Internal Medicine at Banner MD Anderson in Gilbert.

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Together, hematologists, oncologists, radiologists, surgeons and other cancer specialists devise and implement treatment plans tailored to the

individual needs of each patient. For Stanley, suspicion of cancer led to blood tests and bone surveys at Banner MD Anderson, where he now is under the care of hematologist Javier Munoz, MD for a type of blood cancer known as smoldering multiple myeloma. “At this stage in the illness, there isn’t anything that can be done in terms of treatment,” Stanley says. “At some point, the cancer will flip and become a full-blown myeloma. That’s when we’ll start treatment. For now, we’re watching it and waiting.”

I’m amazed at what these people do for patients. Your fears and anxiety really mean something to them and you never feel like you’re alone. carl stanley, cancer patient Fighting chance While waiting is never fun, at least Stanley understands what he’s dealing with and can take comfort in knowing he has a team of specialists ready to help him fight when the time is right. “I know it sounds like a cliché, but I became part of the [Banner MD Anderson] family the minute I walked in the door,” Stanley says. “I’m amazed at what these people do for patients. Your fears and anxiety really mean something to them and you never feel like you’re alone.” •ch

The Suspicion of Cancer Clinic sees patients 18 and up with appointments held Monday thru Thursday. For more information or to schedule an appointment, please call 480-256-6444.

A CEO’s giving spirit

aul Oreffice is well known by people around the country, and even the world, for his fascinating personal story – that of an Italian immigrant who arrived in the United States at age 18 speaking very little English and worked his way through the ranks to become CEO of a major corporation. Equally important, but perhaps shared less frequently, is the story of Paul’s generosity and commitment to giving back. Paul, along with his wife Jo Ann, has been an active volunteer and donor for numerous causes and organizations. That generosity extends to Banner MD Anderson Cancer Center, which Paul says, “is simply a “newer, more modern version of The University of Texas MD Anderson Cancer Center.” And he would know. In 2009, Paul and Jo Ann received the news that he had follicular lymphoma cancer. Paul’s business experiences had taught him how Paul and Jo Ann Oreffice to turn obstacles and setbacks into achievements and success, and his battle against cancer would be no different. As the result of previous research into the country’s top cancer centers Paul was already engaged with The University of Texas MD Anderson Cancer Center, so it was a natural choice for his treatment and care. Paul’s amazing team of doctors and other care professionals at MD Anderson turned a grim diagnosis into hope and healing and he is currently cancer-free. His positive experience led to personal involvement with the cancer center as a donor and volunteer. Paul currently serves on MD Anderson’s Board of Visitors, an appointed board of volunteers who advance the institution’s mission. In the years since his treatment, Paul has referred numerous family, friends and acquaintances to MD Anderson for care and is always proud to share their amazing stories of healing. So, when it was announced that MD Anderson would partner with Banner Health to bring the world’s leading model of cancer care to the Valley where Paul and Jo Ann have a home, he was thrilled and quickly looked to get involved. In addition to Paul’s willingness to share his personal story to help and encourage others, he and Jo Ann have made a generous gift of $200,000 to Banner MD Anderson Cancer Center. The donation will support a new cancer prevention education program in partnership with a local school district. In addition, Paul recently celebrated his 85th birthday and asked for donations to Banner MD Anderson in lieu of gifts – a gesture that generated more than $40,000 to support the many programmatic and operational elements of the cancer center that are made possible through philanthropy.

For information on giving opportunities to support Banner MD Anderson Cancer Center, visit www.BannerHealth.com/GivingBack or call 602-747-GIVE (4483).

BannerMDAnderson.com

Nutrition

Eat fresh, lay off the fat A healthy diet rich in veggies and fruits aid in cancer prevention

By Gremlyn Bradley-Waddell healthy diet is

important for cancer prevention but there are no magical foods that do it alone. Instead, says Heather Metell, eating right in order to ward off cancer starts with a plant-based diet comprised of a diverse number of whole foods — eaten fresh when possible — with limits on fats, refined and processed foods and one’s intake. It’s sound advice for everyone, she adds. “The best foods come without a wrapper,” says Metell, executive chef at Banner MD Anderson Cancer Center and Banner Gateway Medical Center in Gilbert. “The fewer steps there are in preparation of the food, the lesser the chance that the nutrients are going to be damaged.” So, choose an apple, not an appleflavored pastry. Speaking of apples, eat all the fruits and vegetables you want, she says, including the “superfoods” from the cruciferous family, broccoli and kale. In fact, she says, veggies and fruits should take up most of the plate. “We need to make meat more of a side dish,” Metell says, adding that

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Heather Metell, executive chef at Banner MD Anderson in Gilbert.

if you must have meat, spend more for the higher-quality, grass-fed and responsibly raised variety, or when buying fish, opt for wild-caught versions. By eating less of it, she adds, pricier types won’t be as much of an economic impact. Increasing one’s fiber intake by eating more whole grains is also a smart move. Metell advocates quinoa, wheat berry and barley in addition to brown rice. And while she doesn’t expect folks to go cold turkey and give up butter, she encourages lightening up on saturated fats and substituting with products like avocado and olive oils. Finally, don’t get sabotaged by what she calls “portion distortion,” as typified by steakhouses serving 10-, 12-, and 16-ounce cuts. “We don’t need that much protein,” she says. A portion should be about as big as your fist. To combat portion distortion, use a smaller plate and drink a glass of water before meals. Also, appreciate your food. “Human beings have a tendency to feed and not dine,” she says. “Remember to ‘consciously eat.’ ” •ch

RECIPE Barley Pilaf ¼ cup diced roasted red pepper ¼ cup sliced mushrooms 3 cups cooked barley 3 each green onion (chopped) ¼ cup Parmesan cheese (shredded) 2 cloves garlic (crushed) ½ cup white wine ¼ cup sundried tomato (diced) 1 lemon (juice and zest) ¼ cup green bell pepper (small dice) 2 Tbsp. basil (finely chopped) ¼ cup carrot (small dice) 1 /8 cups celery (diced) 1 Tbsp. olive oil Sauté all vegetables in oil until semi-soft, add garlic and shallots, sauté another minute. Add wine and reduce by half. Toss in cooked barley and the remaining items, excluding the cheese. Top with cheese and garnish with fresh basil.

Prevention

Early detection, prevention key to skin cancer patient’s survival New therapies to fight melanoma on horizon By Gremlyn Bradley-Waddell

little pink spot, about

the size of a pencil eraser, appeared on Ladd Smith’s right leg about a year and a half ago. At first, the married father of four figured he scraped himself doing yard work, but he became concerned when the spot didn’t go away after six or seven months. After the doctor who administered a routine physical exam said he wasn’t sure what the mark was, but that he could biopsy it, Smith decided to see a dermatologist. Soon after that appointment, he found himself meeting with oncologists Jade Homsi, M.D., and Mark Gimbel, M.D., of Banner MD Anderson Cancer Center in Gilbert and learning exactly what that little pink spot meant.

Taking no chances “It was metastatic melanoma, and it was going up my lymph nodes,” Smith says, recalling the December 2011 skin cancer diagnosis that shook him to his core. “I thought I was going to die.” The 43-year-old, self-employed nurse anesthetist from Queen Creek says he’s always been the healthy and athletic type; even during that routine physical, “everything was perfect,” he says. But since the tiny melanoma had metastasized, or spread, to the right side of Smith’s groin, the oncologists didn’t want to take any chances on the cancer moving any further through his body. Smith had 18 lymph nodes

removed and followed that with a course of interferon therapy, which left him incredibly weak, caused him to lose weight and his nails, and thinned his hair. “It was pretty tough stuff,” he says. “I’m glad to be off of it.” For now, Smith must have a CT scan and see the doctor every three or four months to make sure the melanoma hasn’t spread to any other organ, and he’s just now starting to regain his strength. Homsi says it’s estimated that one in 59 Americans will be diagnosed with melanoma in his or her lifetime, and that one person dies from the disease every hour. Melanoma has been on the increase over the past three decades and, unfortunately, no one knows why. The good news, the doctor adds, is that the five-year survival rate for someone whose melanoma has been caught early is deemed to be greater than 95 percent.

Early detection is best defense “While researchers are continuing to investigate new therapies to improve melanoma outcomes and the Food and Drug Administration has approved three melanoma drug therapies since 2011, prevention and early detection remain the best defense,” Homsi says, noting Banner MD Anderson has one melanoma clinical trial underway and two more opening shortly. In an odd way, Smith is glad to

Melanoma, one of the most serious forms of skin cancer, starts in the pigment cells. have gone through this experience. He said he’s met wonderful people as a result, including Homsi, with whom he enjoys deploying his gallows humor, as well as countless Banner MD Anderson doctors, nurses and fellow cancer patients. And although he’s not proud of it, he admits he wasn’t always sympathetic to others going through health crises like the kind he’s been dealt. In fact, before his own runin with melanoma, he heard an acquaintance had received a diagnosis, and Smith says his silent reaction was, “Get it cut out and move on.” Now, along with his newfound appreciation of the disease, he’s found a true sense of sympathy and empathy. “I just didn’t get it,” he says. “I didn’t realize melanoma can kill you.” •ch BannerMDAnderson.com

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Events

Classes

To learn more about these events or to register, please visit www.BannerMDAnderson.com.

Palliative Care: What is it and how can it benefit the cancer patient/survivor? June

Time: 6 to 7:30 p.m. Location: Grand Canyon Conference

Redefining yourself after cancer and addressing fear of reoccurrence July

Rooms at Banner Gateway Medical Center RSVP: Call 602-230-CARE Palliative Care is a wonderful resource cancer patients can utilize to improve quality of life. Join Banner MD Anderson Cancer Center and Dr. Kerry Tobias to learn about the benefits of palliative care for the newly diagnosed patient with cancer, those during cancer treatment and cancer survivors. Dr. Kerry Tobias is certified as an American Board of Physical Medicine and Rehabilitation Physician with Subspecialty Certifications in Pain Management and Hospice and Palliative Medicine.

Time: 6 to 7:30 p.m. Location: Grand Canyon Conference

Rooms at Banner Gateway Medical Center RSVP: Call 602-230-CARE Battling cancer is life changing. Cancer survivors struggle with life after cancer and redefining themselves and their relationships at work, with family and with friends. In addition cancer survivors can struggle with the fear of reoccurrence. Please join Banner MD Anderson Cancer Center in our Cancer Survivorship series to address these issues and more importantly learn ways to cope with these changes and improve quality of life.

Nutrition and Exercise Prescription for the Cancer Survivor with Cooking Demo August

Time: 6 to 7:30 p.m. Location: Grand Canyon Conference

Rooms at Banner Gateway Medical Center RSVP: Call 602-230-CARE Join Banner MD Anderson Cancer Center to learn about the latest research in nutrition and exercise to improve treatment related side effects, symptom management and decreases risk of reoccurrence in cancer survivors. Cooking demonstration included.

For more information Banner MD Anderson Cancer Center

On the campus of Banner Gateway Medical Center U.S. 60 and Higley Road in Gilbert To schedule an appointment, call 480-256-6444

Check out our website

bannermdanderson.com

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