UMASS MEMORIAL HEALTH CARE
2017 ANNUAL REPORT OF CANCER SERVICES
AN EXTRAORDINARY SYSTEM OF PERSONALIZED PATIENT CARE Dear Colleagues: It is our pleasure to share with you the 2017 Annual Report of Cancer Services. For the very first time, this Annual Report is a showcasing of the extraordinary cancer care provided to our patients throughout the UMass Memorial Health Care system. When people hear a hospital name, they often associate it with a site or building. What makes UMass Memorial truly stand apart is that our care extends beyond a single bricks and mortar location. We provide an unparalleled network of cancer care throughout Central Massachusetts at our Medical Center in Worcester and our member hospitals UMass Memorial HealthAlliance-Clinton Hospital and UMass Memorial – Marlborough Hospital. In this very special Annual Report, you will see the exquisite Healing Garden, a true jewel in cancer care, providing a peaceful, visual respite for both patients and medical caregivers alike at our Cancer Center at Marlborough Hospital. Read about how a patient might begin with patient rehabilitation on our Memorial Campus in Worcester and then continue working with our dedicated physical therapy team in Clinton. In Worcester we are one of the few clinics in the country to be taking part in the TMIST Protocols breast cancer clinical trials. As the clinical partner of the UMass Medical School, our patients have access to some of the emerging innovations and treatment options through the clinical trials offered via the medical school affiliation. Patients may be treated at one of our member hospitals, close to home and in a familiar community hospital setting, but still have access to this world-class innovative medicine. As many know, melanoma is one of the deadliest forms of cancer, and our team is offering the same immunotherapy options at our Medical Center as was successfully provided to Former President Jimmy Carter. One of the biggest steps forward as a dedicated system of health care was the implementation of the Epic electronic health record system in October 2017. This platform gave us the ability to standardize more than 600 chemotherapy regimens across our system. One of the most significant benefits of this initiative is that it enables every member of the cancer patient’s care team to see the entire patient record and access to all the relevant information when making treatment decisions, taking our patient care to an exemplary new level. Finally, we are proud to share with you a piece on the ground-breaking work of the UMass Cancer Avatar Program, which showcases our commitment not simply to provide the best treatments currently available, but also to developing the cures of the future. Across the UMass Memorial Health Care system, a dedicated, compassionate team of health care providers come together each and every day to provide our cancer patients the best care possible. We are proud to share a few examples of their incredible work in this very special Annual Report. Sincerely,
William Walsh, MD
Nahida Islam, MD
Allison Sacher, MD
Madhavi Toke, MD
Giles Whalen, MD
Interim Clinical Chief, Division of Hematology/Oncology
Hematology-Oncology
Radiation Oncology
Hematology-Oncology
UMass Memorial Medical Center
UMass Memorial Medical Center
Chief, Division of Surgical Oncology and Endocrine Surgery
Interim Medical Director, Clinical Research Office
Medical Oncology UMass Memorial Medical Center
UMass Memorial Cancer Center at Marlborough Hospital
Simonds-Sinon Regional Cancer Center, UMass Memorial HealthAlliance-Clinton Hospital
Interim Director, Cancer Center Interim Chair, Cancer Committee UMass Memorial Medical Center
UMass Memorial Cancer Center at Marlborough Hospital
Vice Chair, Department of Surgery UMass Memorial Medical Center
TABLE OF CONTENTS An Extraordinary System of Personalized Patient Care ...................................................................................................................................... 2 Looking to the Future: Welcome Jonathan Gerber, MD, as Division Chief for Hematology-Oncology and Medical Director of the Cancer Center ................................................................................................................................................................... 4 The Dana-Farber Cancer Care Collaborative ................................................................................................................................................................. 5 Cancer Clinical Research and The Conquering Diseases Program........................................................................... 5 Best Mammography Technology for Breast Cancer Screening? UMass Memorial Participates in Major TMIST Clinical Trial to Find Answer.
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UMass Memorial Health Care Mammography Services...................................................................................................................................... 8 The Healing Garden – Cultivating a Peaceful Experience for Patients Undergoing Cancer Treatment ............ 9 Dedicated Melanoma Program Offers New Treatments, New Hope ................................................................................................... 10 Celebrating A Major Milestone: The 20th Annual UMass Cancer Walk & Run ....................................................................... 11 The UMass Cancer Avatar Institute: Humanized Mice Help Advance Immunotherapy Research
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A Far-Reaching Network of Community Cancer Care ....................................................................................................................................... 13 Cancer Rehabilitation Services: Helping Patients Reclaim Their Lives After Cancer Treatment ....................... 14 UMass Memorial Takes Patient Care to Exemplary New Level With “Epic” Standardization of Chemotherapy Regimens .......................................................................................................................................................................................................... 16 Ushering in An Epic New Era at UMass Memorial ................................................................................................................................................ 17 National Accreditations......................................................................................................................................................18
Cover photo: Detail from the Healing Garden. See related story on Page 9.
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LOOKING TO THE FUTURE: WELCOME JONATHAN GERBER, MD, AS DIVISION CHIEF FOR HEMATOLOGY-ONCOLOGY AND MEDICAL DIRECTOR OF THE CANCER CENTER We are pleased to announce that Jonathan Gerber, MD, will be joining UMass Memorial Medical Center and UMass Medical School in August 2018 as the Division Chief for HematologyOncology and Medical Director of the Cancer Center. Dr. Gerber holds undergraduate and medical degrees from Johns Hopkins University, where he completed a residency in internal medicine and a fellowship in hematology. He served on the faculty of the Johns Hopkins School of Medicine for five years in the Division of Hematology. In 2013, Dr. Gerber joined the newly created Levine Cancer Institute of the Carolinas HealthCare System in Charlotte, North Carolina as founder and head of the leukemia program, and to help start the Blood and Marrow Transplantation (BMT) Program. His clinical interests include BMT, acute leukemia, chronic myeloid leukemia, myelodysplastic syndromes, myeloproliferative neoplasms and related hematologic conditions.
Jonathan Gerber, MD
Dr. Gerber will build on his experience as director of the Leukemia Division and medical director of hematology at the Levine Cancer Institute to lead the UMass Memorial Hematology-Oncology Division. At the Levine Cancer Institute, Dr. Gerber was a key member of the team that performed the first allogeneic BMT in an adult in the city of Charlotte in March 2014, and he oversaw the creation of a new inpatient service line. He and the team at Levine Cancer Institute have now performed nearly 400 BMTs, with outcomes among the best in the nation. Their patient volumes in leukemia and other hematologic diseases have more than tripled since the inception of the program. Dr. Gerber has maintained an active research program at the Levine Cancer Institute as the co-director of the Hematologic Oncology Translational Research laboratory and an investigator on early phase clinical trials. His research focuses on improving the identification and targeting of the stem cells at the root of leukemia and related diseases, with the goal of personalizing therapy and developing better treatments that are more effective and less toxic. The assay that he developed to detect leukemia stem cells (and distinguish them from their normal counterparts) was granted a U.S. patent in 2015 and it has since been translated into a clinical trial.
Dr. Gerber will continue this research at UMass Medical School. Dr. Gerber plans to build a preeminent program in hematology-oncology, offering the highest quality patient care, training top fellows and performing cutting edge research. He will significantly expand the division and its clinical research program, and establish a robust translational research pipeline in collaboration with the UMass Medical School basic science faculty. He will work with key partners from other disciplines to grow the Cancer Center.
“We look forward to bringing cutting edge discoveries from the world class laboratories at UMass Memorial into the hands of our expert clinical teams to develop promising, new therapies and deliver the highest quality of care to all patients.” “I am very excited to be joining the UMass Memorial team at this pivotal time in cancer care,” said Dr. Gerber, adding, “We look forward to bringing cutting edge discoveries from the world class laboratories at UMass Memorial into the hands of our expert clinical teams to develop promising, new therapies and deliver the highest quality of care to all patients.” Dr. Gerber will be joined by his wife Lisa and their two children, Will and Gracie, who are excited about moving to New England. Please join us in welcoming Dr. Gerber!
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THE DANA-FARBER CANCER CARE COLLABORATIVE The Cancer Center at UMass Memorial Medical Center recently celebrated the first anniversary as a proud member of the Dana-Farber Cancer Care Collaborative for Adult Medical Oncology. UMass Memorial is the first academic medical center to hold this prestigious distinction. Being a member of this collaborative means that our Cancer Center has demonstrated a commitment to excellence by meeting a wide array of standards and best practices in cancer care. The collaboration provides our patients with especially complex cancers expedited access to DanaFarber specialists and enhanced specialized educational, training and consultation opportunities for Medical Center caregivers. For more information, call our HOPE Line at 866-597-HOPE (866-597-4673).
Proud member of Dana-Farber Cancer Care Collaborative 855-UMASS-MD
CANCER CLINICAL RESEARCH AND THE CONQUERING DISEASES PROGRAM UMass Memorial Health Care is the clinical partner of the UMass Medical School, a leader in clinical trials and medical breakthroughs. Cancer clinical trials are conducted by The Conquering Diseases program. The Conquering Diseases Program is the name given to a research project within the UMass Medical School which hopes to discover the keys to better health in our community. The Conquering Diseases Program is a partnership between community members, the patients being cared for by the health professionals of UMass Memorial Health Care and the research community. The Conquering Diseases Program consists of three components: a Clinical Research Volunteer Registry, a Biorepository and a Community Resource Center. These
three components are available to researchers, patients and community members alike. The ultimate goal of Conquering Diseases is to gain a better understanding of the diseases our patients suffer from, how to prevent these diseases and how to better treat these afflictions. The Conquering Diseases programs are supported by the National Center for Advancing Translational Sciences, National Institutes of Health. For more information or for a list of open clinical trials, please go to: www.umassmed.edu/conqueringdiseases/ clinical-studies/
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BEST MAMMOGRAPHY TECHNOLOGY FOR BREAST CANCER SCREENING? UMASS MEMORIAL PARTICIPATES IN MAJOR TMIST CLINICAL TRIAL TO FIND ANSWER. UMass Memorial Medical Center is participating in a major National Cancer Institute-funded clinical trial that aims to definitively determine if 3-D mammography (tomosynthesis) is better than 2-D digital mammography for breast cancer screening. The ECOG-ACRIN Cancer Research Group is leading the trial. TMIST (Tomosynthesis Mammographic Imaging Screening Trial) is a randomized trial comparing 3-D and 2-D mammography. Even though both methods are FDAapproved and in use, researchers do not know whether the newer 3-D technology tops conventional mammography at early detection of aggressive breast cancers. Nearly 100 mammography clinics across the United States and Canada will be participating in the trial, with researchers enrolling an estimated 165,000 healthy women over the next few years.
“TMIST will answer the question if tomosynthesis really is reducing the chances for a woman to develop a life-threatening, or advanced, cancer compared with digital mammography, and whether it should become the standard of care for breast cancer screening.”
Gopal Vijayaraghavan, MD, is the director of the Division of Breast Imaging and the principal investigator for TMIST at UMass Memorial.
Dr. Vijayaraghavan and his team hope to enroll two to three women per day over the next two-to-three-year period, for a total accrual of about 1,500 to 2,000 patients. The goal of screening is to find breast cancer early, when it tends to be easier to treat. Standard 2-D mammography takes pictures from two sides of the breast to create a flat image, while tomosynthesis takes images from several different angles around the breast, generating a 3-D-like image. “There have been sporadic papers published suggesting that breast cancer detection rates are better with tomosynthesis, and that recall rates are lower,” Dr. Vijayaraghavan says. Recall rates refer to when women must return for additional views after their initial mammogram. “But we need big numbers to prove what’s beneficial and what’s not.” “So because of its size and scope, TMIST will answer the question if tomosynthesis really is reducing the chances for a woman to develop a life-threatening, or advanced, cancer compared with digital mammography, and whether it should become the standard of care for breast cancer screening,” he adds. But the trial’s benefits don’t stop there.
“We perform a lot of breast cancer screening here at UMass Memorial, handling about 40,000 cases a year,” says Gopal Vijayaraghavan, MD, director of the Division of Breast Imaging, who is serving as the principal investigator for TMIST at UMass Memorial. “We think it is important to participate in this study and help provide whatever answers we can.”
TMIST is building a biobank for future research, and all women who join the trial will be asked to submit blood samples and swabs of cells from inside their mouths. Researchers hope that information from these samples will help determine the best ways to screen for breast cancer in the future by taking into account a woman’s genetics and other personal risk factors.
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“In the course of the trial, some women may have a finding and undergo a biopsy,” Dr. Vijayaraghavan explains. “These biopsy tissue samples will be compared to the patient’s genetic profile. As a secondary aim of the TMIST study, we hope to determine if there are tumor markers that can help us predict who’s more likely to get these cancers, or if we can predict the aggressiveness of certain cancers.” “TMIST is framing the question, ‘Does tomosynthesis detect cancers earlier before they become advanced, so we can provide treatment earlier?’ ” he notes. “It’s hoped that based on mammography morphology, we’ll be able to identify tumors that are more aggressive and tailor treatment accordingly.” HOW TMIST WORKS
Any woman aged 45 to 74 who is planning to undergo a routine screening mammogram is eligible to enroll in TMIST. Women who meet these criteria and schedule a regular screening mammogram at any of the ten UMass Memorial mammography sites will be offered the opportunity to join the study, but they must undergo their exams at Shrewsbury Mammography at 26 Julio Drive. Please see page 8 for information on mammography locations and hours. “Conducting the study at a single site helps to ensure consistency in the technology, staff and reading radiologists,” Dr. Vijayaraghavan says. Once enrolled in the trial, women will be randomly assigned to receive either 3-D or 2-D screening mammograms for five years. The frequency of the screening mammograms will be based on their age, breast density, family history of breast cancer, presence of genetic changes known to cause breast cancer, use of hormone replacement therapy (HRT) and menopausal status. Women with symptoms of nipple discharge or breast lumps, prior personal history of breast cancer or ductal carcinoma-in-situ and those with breast enhancements are not eligible to participate in the study. Dr. Vijayaraghavan stresses that volunteers will be screened to ensure they meet stipulated criteria for participation in the study. If a woman’s risk changes, it is possible that the frequency and number of mammograms she receives will change during her time in the study. During the trial, the results from each participant’s mammograms will be collected, regardless of whether the mammograms are normal or not. Information about any medical follow-up—such as additional imaging or a biopsy—will also be recorded. TMIST researchers intend to follow all participants for breast cancer status,
“It’s hoped that based on mammography morphology, we’ll be able to identify tumors that are more aggressive and tailor treatment accordingly.” treatment and the results of treatment from the time of randomization until the end of the study (at least 2025). “In addition, we will follow women for three years after the study,” Dr. Vijayaraghavan says. During this time, women and their primary care doctors will determine what type of mammogram they will have. Based on the findings of earlier studies, researchers know that the vast majority of women in the study will not develop breast cancer. If a woman does receive a diagnosis of any kind of breast cancer while in the trial, she will receive treatment just as she would if she was not part of TMIST, while continuing to be part of the trial. Participants’ health plans will be billed for the cost of mammograms during the study. Some health plans do not cover the complete cost of 3-D mammograms so if a woman is randomly assigned to receive tomosynthesis, she may need to pay for the portion not covered, just as she would if she weren’t part of the study. “In today’s world, mammography is the standard of care for screening for breast cancer,” Dr. Vijayaraghavan says. “But we don’t yet know if digital mammography is good enough, or if tomosynthesis should be the standard of care. In a few years, thanks to TMIST, we should have the answer.”
FOR MORE INFORMATION
The TMIST clinical trial is scheduled to open for patient enrollment in the Fall of 2018. To learn more or for information on participating, please call 508-856-3216 or email cancer.research@umassmed.edu.
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UMASS MEMORIAL HEALTH CARE MAMMOGRAPHY SERVICES BARRE Barre Family Health Center 151 Worcester Road Monday 9 am - 6 pm Tuesday 8 am - 5 pm Wednesday 11 am - 6 pm Thursday 9 am - 12 pm Friday 9 am - 5 pm CLINTON UMass Memorial HealthAlliance-Clinton Hospital Clinton Campus 201 Highland Street Monday 7:30 am - 4:30 pm Tuesday 7:30 am - 6:30 pm Wednesday 7:30 am - 4:30 pm Thursday 7:30 am - 4:30 pm FITCHBURG UMass Memorial HealthAlliance-Clinton Hospital Burbank Campus 275 Nichols Road Monday 10:30 pm - 6:30 pm Thursday 8:30 am - 4 pm LEOMINSTER 3D UMass Memorial HealthAlliance-Clinton Hospital Leominster Campus 60 Hospital Road Monday 7 am - 8 pm Tuesday 7 am - 8 pm Wednesday 7 am - 8 pm Thursday 7 am - 4 pm Friday 7 am - 4 pm Saturday 7 am - 12:00 noon, every other week SHREWSBURY 3D Shrewsbury Mammography 26 Julio Drive
SOUTHBOROUGH 3D UMass Memorial – Marlborough Hospital Women’s Imaging Center 28 Newton Street Monday 7:30 am - 8 pm Tuesday 7:30 am - 8:30 pm Wednesday 7:30 am - 8 pm Thursday 7:30 am - 4:30 pm Friday 7:30 am - 4:30 pm Saturday 7:30 am - 12:30 pm UXBRIDGE 3D Tri-River Family Health Center 281 Hartford Ave East Monday 9 am - 8 pm Tuesday 8:30 am - 2 pm Wednesday 8:30 am - 5 pm Thursday 8:30 am - 2 pm Friday 9 am - 2 pm WORCESTER UMass Memorial Medical Center Hahnemann Campus Hahnemann Mammography Center 281 Lincoln Street Monday to Friday 7:30 am - 4 pm UMass Memorial Medical Center Memorial Campus Memorial Mammography Center 119 Belmont Street
3D
Monday to Friday 7:30 am - 4 pm Tuesday Until 6 pm Wednesdays: Until 7 pm UMass Memorial Medical Center Ambulatory Care Center University Campus 55 Lake Ave North
3D
Monday to Friday 7:30 am - 4 pm
Monday to Friday 7:30 am - 4 pm Saturday 7:30 am - 2 pm
Call 855-UMASS-MD (855-862-7763) for more information or to schedule your mammogram.
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THE HEALING GARDEN – CULTIVATING A PEACEFUL EXPERIENCE FOR PATIENTS UNDERGOING CANCER TREATMENT In architecture, “form follows function” is a principle that says the design of a building should relate to its intended function or purpose. When the decision was made to build the new UMass Memorial Cancer Center at Marlborough Hospital, the intended function wasn’t to merely house cutting-edge cancer treatment resources but, first and foremost, to be a healing environment for cancer patients and their families. By all accounts, the Center’s design is fulfilling that purpose. “We brought together a committee made up of patients, doctors, nurses, donors and consultants who worked together to design a cancer center that was a true beacon of hope for our community,” says Ellen Carlucci, vice president of development, marketing and public relations at UMass Memorial – Marlborough Hospital.
The Healing Garden is a special place for patients and caregivers, thanks to the tireless dedication and generous support of donors including Nancy Hanslip (left) and Erika Wilkinson (right).
Tiny white lights gently illuminate the garden after the sun goes down—which occurs early on short winter days. The garden is visible through large windows from every chair in the center’s Steven E. Salomon Infusion Suite, as is a thoughtfully curated selection of art, much of it created by local artists. The infusion suite is where patients undergo immunotherapy and chemotherapy that’s administered intravenously.
“We used evidence-based research to pick the colors, furnishings, appointments, lighting—everything—to create a state-of-the-art cancer center that promotes healing and compassion,” she continues. “Above all, we wanted people who came here to say, ‘This is a place I feel I can get well.’” A centerpiece of the Cancer Center, which opened its doors in 2014, is a peaceful healing garden that fills a 22-by-80feet outdoor space between the center and Marlborough Hospital’s intensive care unit (ICU). Viewing and interacting with nature have been scientifically proven to reduce stress, lessen negative emotions and aid in the healing process—which is why outdoor gardens have been used to promote healing for centuries. The Cancer Center’s garden features colorful seasonal plantings and a moving water feature. “It is designed to be a relaxing visual experience for the patients receiving care at the Cancer Center,” notes Landscape Architect Nicholas Dines, who oversaw the garden design process. “As the garden matures, it provides images of color and seasonal change for patients and staff.”
“Our goal was to give patients something beautiful and calming to look at while they’re having infusion therapy, which can take several hours,” Carlucci says. “We wanted the art and garden to perhaps trigger fond memories, or help them be mentally transported away while they’re undergoing treatment.” Similarly, the ceiling in the Radiation Oncology suite is covered in nature-inspired wallpaper based on artwork from a Philadelphia museum, giving patients something to gaze at while they’re lying on the treatment table. Patients in the ICU—on the opposite side of the garden from the Cancer Center—also can look out on the tranquil setting. In addition, Carlucci notes that the garden also provides a peaceful visual respite for the caregivers who work at the Cancer Center. “It’s not easy being an oncology nurse, doctor or tech,” she says. “They have to be present for people who are scared, uncomfortable and anxious. The garden is here for the caregivers, too. “We really do represent a beacon of hope for the community,” Carlucci adds. “With this center, we’re able to provide excellent cancer care, and it’s conveniently right here in their own backyard. Equally important, our care is provided in an environment that’s specially designed for comfort and healing.”
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DEDICATED MELANOMA PROGRAM OFFERS NEW TREATMENTS, NEW HOPE “At one time not too long ago, advanced melanoma was a pretty hopeless diagnosis,” says Mary Maloney, MD, chair of the Department of Dermatology at UMass Memorial Medical Center, referring to the deadliest form of skin cancer. “But today, immunotherapy is providing tremendous benefits for people with advanced disease.” Former President Jimmy Carter, 93, is a recent and notable case in point. In 2015, he was diagnosed with metastatic melanoma that had spread to his liver and his brain, and thought he had just weeks to live. But in addition to undergoing surgery and radiation to treat the lesions in his brain, Carter received an immunotherapy drug—pembrolizumab—which the Food and Drug Administration approved in 2014 for treating advanced melanoma. Four months after his surgery and radiation treatment, he publicly announced he was cancer-free after brain scans detected no signs of cancer. His doctors discontinued his immunotherapy treatments three months later. “These new biologics are really wonderful for this group of patients,” Dr. Maloney says, noting that newer targeted therapies continue to be tested and brought to market with remarkable frequency.
“We have a truly robust program with a full array of treatment options for every stage of melanoma, and a talented, multidisciplinary team that works well together.” UMass Memorial Medical Center joined the collaborative in 2016—the first academic medical center to do so. This affiliation not only provides UMass Memorial patients with especially complex cancers expedited access to Dana-Farber specialists, but also enhances specialized educational, training and research opportunities. [See related story on the Dana-Farber Cancer Collaborative on page 5.] “But our first line of defense against melanoma continues to be early diagnosis, when this type of cancer is completely curable with surgery alone,” Dr. Maloney stresses. “For thin melanomas, either in situ or those that are less than 0.75 millimeters in thickness, surgery is curative and the treatment of choice.” Melanoma in situ, also called stage 0 melanoma, means cancer cells are only in the top layer of skin (the epidermis).
Mary Maloney, MD, stresses that the first line of defense again melanoma is early diagnosis.
“We are involved in clinical trials both here at UMass Memorial and through our affiliation with Dana-Farber,” she says, referring to the renowned Dana-Farber Cancer Institute and its Cancer Care Collaborative.
“There are two types of surgery commonly performed to treat these thin melanomas,” she explains. “The first is straight surgical excision, which is available at both UMass Memorial HealthAlliance-Clinton Hospital as well as UMass Memorial Medical Center. The second surgical technique, called slow Mohs surgery, is only performed in Worcester.” With slow Mohs, the surgeon removes the visible skin cancer and a bit of normal-looking skin around it. The patient is bandaged and sent home while a pathologist examines the removed skin to see if the margins are clear of cancer. Most patients return the next day to learn whether more skin must be removed or the wound can be closed.
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CELEBRATING A MAJOR MILESTONE: THE 20TH ANNUAL UMASS CANCER WALK & RUN
20th ANNUAL CANCER WALK & RUN SUNDAY, SEPTEMBER 30, 2018 University Campus REGISTER NOW! www.umassmed.edu/cancerwalk
TAR FUNS DRAIT SIN TODA Y! G
On September 30, 2018, thousands of individuals will come together for the 20th Annual UMass Cancer Walk & Run on the University Campus in Worcester. Patients, friends, families, passionate individuals, business leaders, employees and community organizations come together at this very special event to raise funds supporting cancer research and care at the UMass Memorial. To make a donation or to learn more about how to participate, please visit https://www.umassmed.edu/cancerwalk
Because his melanoma was detected at its earliest stage by a vigilant primary care physician (PCP), Hopkinton resident Michael O’Brien, 65, was a candidate for straight surgical excision. “I’d gone to see my primary care doctor about a patch of dry skin on my forehead that wouldn’t go away,” O’Brien relates. “Fortunately, it wasn’t cancerous and could just be frozen off. While I was there though, my doctor suggested he also do a full-body examination to check for skin cancer and that’s when he discovered a small black spot on my back. “He didn’t seem too concerned but thought we should definitely have it biopsied,” O’Brien continues. “Turns out, it was melanoma in situ.” O’Brien’s PCP referred him to UMass Memorial Medical Center, which has a dedicated melanoma program with a multidisciplinary team of dermatologists, surgical
oncologists, plastic surgeons, radiation oncologists and medical oncologists. “I was able to be seen by dermatologist Bassel Mahmoud, MD, within two weeks,” he says. “And he was able to get me in that day for surgery. Rather than come back, I figured ‘why not?’ “It went very well,” O’Brien says. “I had surgery on a Friday, and got a reassuring pathology report on Monday that said they’d gotten it all. I was very impressed by the care I received. And it was comforting to know that this is something that Dr. Mahmoud does all the time—and he’s been doing it for a long time.” “We have a truly robust program with a full array of treatment options for every stage of melanoma, and a talented, multidisciplinary team that works well together,” Dr. Maloney says. “There’s really no reason to go anyplace else.”
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THE UMASS CANCER AVATAR INSTITUTE: HUMANIZED MICE HELP ADVANCE IMMUNOTHERAPY RESEARCH The institute, which provides a forum for collaboration between clinicians and basic scientists, provides mice engineered as avatars of individual human-patient tumors. “Because the NSG mice are immunodeficient, their ability to reject tissue from humans is severely compromised or entirely absent,” Dr. Whalen explains. “This makes it possible not only to grow human tumors in them, but also to put in a human immune system. We can then study how these cancers shut down a patient’s immune response against them. We can also test the effectiveness of various therapies aimed at re-energizing immune system attacks against the cancer.” The UMass Cancer Avatar Institute is a powerful model for translational research collaboration, explains Giles Whalen, MD.
An avatar is something that embodies something else. In Hinduism, when deities take human forms, the human is called their avatar. In the online world, an avatar is an image that represents you in video games or chat rooms. In the world of medical research, however, an avatar can be a mouse that has been “humanized.” This means it carries functioning human genes, cells, tissues or organs, and can be used as a model to study the effectiveness of human therapies. UMass Memorial Medical Center first became involved in mouse avatars through the work of Dale Greiner, PhD, the Dr. Eileen L. Berman and Stanley I. Berman Foundation Chair in Biomedical Research Professor and professor of molecular medicine at UMass Medical School, and co-director of the UMass Memorial Diabetes Center of Excellence. Working closely with scientists at the renowned Jackson Laboratory in Maine, Dr. Greiner helped create what’s called the NSG mouse, a special brand of mouse without a normal immune system. Instead, it can be engrafted with a human immune system, enabling scientists to study how the immune system has an impact on several different kinds of human disease—without putting patients at risk. While Dr. Greiner’s work originally focused on type 1 diabetes—an autoimmune disease—the mouse avatar he helped develop is now playing a key role in cancer research through the UMass Cancer Avatar Institute. Dr. Greiner helped to establish the Institute with Giles Whalen, MD, chief of the Division of Surgical Oncology and Endocrine Surgery, and vice chair of the Department of Surgery at UMass Memorial Medical Center.
Through the UMass Cancer Avatar Institute, multidisciplinary clinical teams of surgeons, medical oncologists and radiation oncologists who care for patients with these different types of cancer are involved in research projects with scientific collaborators. Oncologic surgeons collect tumors from patients at the time of surgery or biopsy, then basic scientists implant the tumors into the mice, administer novel treatments and monitor the response.
“It’s an important way that clinicians who care for patients with cancer are able to translate their insights and help develop new treatments by working with basic scientists, then bring these new treatments back to their patients.” The UMass Tumor and Tissue Bank, which is part of the institute, serves as a clearinghouse for the tumors used in this research. It’s an open-access biorepository serving both internal and external researchers seeking tumor and tissue samples for cancer research. Dr. Whalen was instrumental in setting up the tissue and tumor bank with Karl Simin, PhD, who now serves as its director.
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A FAR-REACHING NETWORK OF COMMUNITY CANCER CARE UMass Memorial Health Care offers a broad-reaching network of cancer care in the MetroWest and Central Massachusetts communities. It is our goal is to provide our patients with expert, personalized, patient-centered, high-value cancer care and services in a location that is close to home. OUR COMMUNITY HOSPITALS:
At UMass Memorial – Marlborough Hospital, we offer our patients convenient, compassionate cancer care close to home, in a new patient-focused facility. Here you will find infusion services and radiation therapy featuring the latest 4-D imaging. A team approach to your treatment features multi- disciplinary care from many specialists, plus access to some of the most promising clinical trials and research studies, and links to specialized cancer programs such as genetic testing, bone marrow transplant, surgical oncology and more. The centerpiece at this Cancer Center is an outdoor healing garden, cultivating a peaceful experience for the patients undergoing cancer treatment and a soothing respite for the caregivers. At UMass Memorial HealthAlliance-Clinton Hospital, the Simonds-Sinon Cancer Center offers comprehensive, personalized cancer care locally. With services such as medical oncology, radiation therapy featuring the True Beam patient system, a complementary care center with mind-body interventions such as Reiki and massage therapy, a disease-specific patient navigator program, financial counseling, physical therapy and nutrition counseling plus access to more advanced treatments and clinical trials, the Simonds-Sinon Cancer Center is a beacon of hope for residents in the greater North Central Massachusetts region. The center has achieved accreditation from the American College of Surgeons Commission on Cancer and is designated as a Community Cancer Program.
“It’s a powerful model for translational research collaboration,” Dr. Whalen notes. “We originally started with the idea that we’d only collect tumors for which there was a basic science investigator with funded research who could use the mouse models for their studies,” he continues. “But with the way immunotherapies have revolutionized cancer treatments, we’re trying to get every tumor we can and set up a translational pipeline so that we can test the effectiveness of many of the new immunotherapeutic drugs that pharmaceutical companies and our own laboratories are generating. So now we’re looking at all types of cancer, including pancreas, lung, colorectal, breast, kidney, bladder, sarcoma and ovarian.” Immunotherapy is a type of cancer treatment that boosts the body’s natural defenses to fight cancer. It uses substances made by the body or developed in a laboratory to improve or restore the ability of a patient’s immune system to destroy cancer cells instead of using standard chemotherapy drugs alone to kill the cancer.
“By putting human immune systems in mice avatars, our research teams can then stimulate these immune systems to destroy or stop a tumor with various immunotherapeutic agents, and determine which particular immune cells are involved in that process,” Dr. Whalen says. “The mice avatars are a superb tool for understanding which immunotherapy drugs might work or should be developed further, and to understand why a particular treatment is working or not, before taking it into clinical trials with human patients,” he continues. “This UMass program allows us to really take advantage of the revolution in personalized cancer care and immunotherapy that is happening today,” he says. “And it’s an important way that clinicians who care for patients with cancer are able to translate their insights and help develop new treatments by working with basic scientists, then bring these new treatments back to their patients. “This is what forefront cancer care at an academic center like ours is all about,” he adds. “And the promise it holds is tremendous.”
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CANCER REHABILITATION SERVICES: HELPING PATIENTS RECLAIM THEIR LIVES AFTER CANCER TREATMENT For example, in breast cancer patients, shoulder dysfunction is a common problem that can occur after surgery, particularly in patients who have undergone axillary (underarm) lymph node resection, or mastectomy and radiation therapy. “Shoulder exercises can be helpful both before and after treatment to lessen shoulder pain and improve range of motion,” Dr. Baima notes. Lymphedema is another common problem among breast cancer patients—and one that can occur years after treatment has been completed.
Jennifer Baima, MD, blends extraordinary clinical knowledge with compassionate, personalized care when working with cancer patients.
While it is often lifesaving, cancer treatment can be hard on a patient’s body. Side effects from chemotherapy or radiation therapy can have a serious impact on daily life, such as fatigue, weakness, balance and walking issues, joint problems, difficulty swallowing, and pain or lymphedema (a dysfunction of the lymphatic system that causes swelling in an arm or leg). Even too much rest after cancer surgery can lead to muscle atrophy, deconditioning and reduced range of motion. The good news, however, is that customized therapies can help improve everyday function and quality of life for people undergoing cancer treatment. In fact, there is research—some of it conducted here at UMass Memorial— that proves it. Which is why UMass Memorial Health Care provides specialized cancer rehabilitation services as part of its comprehensive cancer care program—something not every cancer program offers. “Patients with different types of cancer have different impairments,” explains UMass Memorial Medical Center physiatrist Jennifer Baima, MD, a board-certified specialist in physical and rehabilitation medicine. “In my role, I’ll meet with a patient to assess what those impairments are, prescribe a therapy program tailored to that patient’s individual needs, and match them up with an experienced physical or occupational therapist, lymphedema specialist, or speech-language pathologist. “There really is no one-size-fits-all approach to rehab from cancer treatment,” she adds.
“Patients with different types of cancer have different impairments. In my role, I’ll meet with a patient to assess what those impairments are, prescribe a therapy program tailored to that patient’s individual needs, and match them up with an experienced physical or occupational therapist, lymphedema specialist, or speechlanguage pathologist.” “There’s no rhyme or reason as to why lymphedema happens,” says Jennifer Baer, PT, CLT, rehabilitation supervisor at UMass Memorial HealthAllianceClinton Hospital, “but a highly specialized massage technique called manual lymph drainage can help relieve the condition, along with education, exercise,
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““Exercise is something they can do that’s within their control, and a growing body of evidence demonstrates that it can and does have a beneficial effect on their outcome. It can improve daily function and quality of life, including mental health and outlook. When you’re dealing with cancer, that’s huge.”
relates. “In this study, soccer training gave these patients an opportunity to take responsibility for their own health without feeling like a patient.” “In my experience, it doesn’t matter what physical activity you do,” she adds. “Doing something is better than nothing, and if it’s something you love that you’ll continue to do, that’s the important thing.” “What’s more, there is considerable evidence that exercise helps prevent recurrence of several types of cancer including colorectal, breast and perhaps lung,” Dr. Baima says, further underscoring the vital role of physical activity in fighting cancer.
and compression garments—all of which we provide or prescribe.” Baer is one of only a handful of professionals in Central Massachusetts who have undergone advanced training to earn certification as a lymphedema therapist, demonstrating a high level of expertise for managing this challenging condition. In patients treated for brain tumors—who often experience weakness and balance impairments as a result of chemotherapy and radiotherapy—resistance (strengthtraining) and endurance exercises not only have been shown to reverse muscle atrophy and weakness but are also strong predictors of survival. And in patients with lung cancer, presurgical aerobic exercise has been shown to improve functional lung capacity and reduce postoperative morbidity. Dr. Baima points to another study in which a specific sport—soccer—was shown to help men undergoing androgen-deprivation therapy for prostate cancer. This type of treatment depletes male hormones, which also reduces muscle strength. “While we know exercise-based rehabilitation can help improve physical capacity and quality of life, compliance among some male cancer patients appeared low,” she
Jennifer Baer, PT, CLT, is a knowledgeable, dedicated lymphedema therapist, providing patients a high level of expertise for managing this very challenging condition.
She acknowledges that getting a cancer diagnosis and going through treatment can seem overwhelming because of the loss of control many patients feel. “But exercise is something they can do that’s within their control,” she stresses, “and a growing body of evidence demonstrates that it can and does have a beneficial effect on their outcome.” “Plus, it can improve daily function and quality of life, including their mental health and outlook,” she adds. “When you’re dealing with cancer, that’s huge.” Cancer rehabilitation services and lymphedema treatment are available by referral from a patient’s oncologist or primary care physician, and are covered by most major health insurance plans.
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UMASS MEMORIAL TAKES PATIENT CARE TO EXEMPLARY NEW LEVEL WITH “EPIC” STANDARDIZATION OF CHEMOTHERAPY REGIMENS Electronic health records (EHRs)—computer software that doctors and nurses use to track all aspects of patient care, support clinical decision-making and streamline care processes—have tremendous potential to enhance the quality, safety and efficiency of patient care. At UMass Memorial Health Care, clinicians are realizing this potential through the use of Epic, one of the largest and most respected providers of health information technology for accessing, organizing, storing and sharing patient medical records. The industry-leading EHR system went live at all four UMass Memorial hospital sites last October 1—the culmination of a massive 2 1/2year implementation process. As part of the enterprise-wide installation, UMass Memorial’s Cancer Care Services completed what was truly an “epic” undertaking when 530 standardized treatment and therapy plans across 26 types of cancer were uploaded into the Epic system in time for the “golive” date. It was an immensely labor-intensive process during which the UMass Memorial oncologists, oncology nurses and pharmacists devoted countless hours to write and verify the standardized regimens as well as enter the individual treatment protocols of all patients currently undergoing treatment. It’s an achievement that’s taking the quality and safety of UMass Memorial’s superb cancer care to an even higher level. “Prior to Epic, we had preprinted order forms with chemotherapy doses and standard anti-nausea regimens,” explains medical oncologist Kathryn Edmiston, MD, codirector of the UMass Memorial Comprehensive Breast Center. “Ordering chemotherapy for a patient involved choosing the appropriate dose and anti-nausea regimen, entering specifics about the individual patient such as height and weight, printing the form, then sending it to the pharmacy to be filled. “But with Epic, all orders are now in electronic format,” she continues, “and it automatically imports all essential patient data. It also allows us to expand on things such as lab parameters, and items that nurses must check before treatment begins, for quality-control purposes. “The goal is not only to standardize chemotherapy but the entire cancer treatment regimen,” Dr. Edmiston adds. “For example, follow-up appointments and lab services are built into every treatment protocol, so if a patient is supposed to be seen every two weeks, the physician must sign off via the system every two weeks.”
Standardization of chemotherapy regiments in Epic ensures a very high quality of comprehensive care, notes Kathryn Edmiston, MD.
One of the most significant benefits of this initiative is that it enables every member of the cancer patient’s care team to see the entire patient record—including imaging, pathology, lab results, cancer support services— and to access all the relevant information when making treatment decisions. “It’s ensuring a very high quality of comprehensive care,” Dr. Edmiston notes. “The standardized regimens are based on best practices for treating every type of solid tumor. Any change you make to a regimen needs to be intentional and well thought out, and the computer provides a safety check. For example, if a patient’s height and weight don’t make sense for a particular chemo regimen, you get an alert. “Communication among the care team is facilitated, too,” she adds. “If I make a change to a treatment regimen, I must record it, so the next person not only knows that a change was made but why.” Safety monitoring is an essential function of the system as well. “Before, we kept a lot of information in our heads, like what a patient’s white blood cell count should be before administering a particular treatment regimen,” Dr. Edmiston says. “But with standardized protocols, we know precisely what the safest practice is for each one. “Similarly, not all oncologists choose the same antinausea medications for their patients, and there may be ten different ones in the literature,” she continues. “But with a standardized treatment regimen, we’ve chosen the
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USHERING IN AN EPIC NEW ERA AT UMASS MEMORIAL When UMass Memorial went live with its new electronic health record (EHR) system Epic in October 2017, it was an “epic” event in more ways than one. Epic is the recognized leader in the world of electronic health records. The software not only has won awards for its functionality and ease of use, but it’s the system that providers and caregivers overwhelmingly prefer. Today, it’s used in more than 1,300 U.S. hospitals, holding the medical records of 54 percent of the nation’s patients. Approximately 190 million patients have a current electronic record in Epic. “We can’t expect to make UMass Memorial Health Care the best place to give care and the best place to get care if we don’t give our staff the best electronic health record system available,” said President and CEO Eric Dickson, MD, when he signed the Epic contract in 2015. “Epic is that system, and it’s more dependable, user-friendly and better integrates all the information our caregivers need to provide the highest quality care possible for our patients.” UMass Memorial has 13,000 employees, and about 1,200 are front-line staff who participated in the selection and implementation of Epic, which replaces a nearly 120 different applications from different vendors. “As an organization, we made it a top priority [to get everyone involved in selecting the new system], said Senior Vice President and Chief Information Officer Tim Tarnowski in an interview with Healthcare IT News last year. “And when I say that, I mean everybody. Everybody who had to get training went to training. Everybody who had to help design the system, participated and engaged.” That involvement translated into a highly successful launch when Epic went live last October 1. In fact, Tarnowski—who’s been involved in previous implementations in his 30-year career—said it was “the smoothest go-live I’ve ever been a part of.” Epic is making it easier than ever to put the patient at the center of all that caregivers do at UMass Memorial. There is now a single sign-on solution for all of a clinician’s needs throughout the work day. (For a closer look at how this works, see the related story on how Cancer Care Services is using Epic to standardize chemotherapy regimens and enhance patient care on page 16.) In addition, Epic provides caregivers and patients a single solution that: •
Makes care coordination more efficient and effective
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Improves communication between care caregivers and patients
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Provides complete and accurate patient and provider information, all in one place
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Improves the patient experience and patient privacy
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Puts population health management tools at caregiver’s fingertips
“The patient will always be the focus of all that we do here at UMass Memorial,” Dr. Dickson adds. “Epic is an amazing tool for helping us do precisely that, more efficiently and effectively.”
one best suited for a particular chemotherapy protocol and made it the standard—and in compliance with national guidelines.” She explains further: “At the same time, if that anti-nausea medication doesn’t work optimally for a particular patient, it’s relatively seamless to modify the regimen to make it better for that patient,” she adds. “Overall, this approach increases patient safety because things are standardized—we’re not starting from scratch
with every order, and there’s less room for error,” Dr. Edmiston stresses. Equally important, patients undergoing cancer treatment at any one of UMass Memorial’s member hospitals are assured of receiving the same high-quality care, since the standardized chemotherapy regimens are used systemwide. “Our physicians and other clinicians have committed a great deal of time and effort to ensure that patients are getting the best, safest cancer treatment they can be given,” she adds. “That’s really at the heart of this entire initiative.”
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NATIONAL ACCREDITATIONS UMass Memorial Health Care is proud to be nationally recognized for providing exceptional medicine to our patients throughout our system. AMERICAN COLLEGE OF RADIOLOGY (ACR): Three-year Accreditation, Radiation Oncology: •
UMass Memorial Medical Center – Memorial Campus
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UMass Memorial Medical Center – University Campus
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UMass Memorial HealthAlliance- Clinton Hospital – Leominster Campus
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UMass Memorial Cancer Center at Marlborough Hospital
Designated Lung Cancer Screening Center: •
UMass Memorial Marlborough Hospital
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UMass Memorial Medical Center – Memorial Campus
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UMass Memorial Medical Center – University Campus
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UMass Memorial HealthAlliance-Clinton Hospital – Leominster Campus
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UMass Memorial HealthAlliance-Clinton Hospital – Clinton Campus
Mammography: •
UMass Memorial Medical Center – Memorial Campus
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UMass Memorial Medical Center – University Campus
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UMass Memorial Medical Center – Hahnemann Campus
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UMass Memorial HealthAlliance-Clinton Hospital – Leominster Campus
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UMass Memorial HealthAlliance-Clinton Hospital – Clinton Campus
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UMass Memorial HealthAlliance-Clinton Hospital – Burbank Campus
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Barre Family Health Center
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Shrewsbury Mammography
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UMass Memorial Marlborough Hospital Women’s Imaging Center
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Tri-River Family Health Center
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AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER: •
UMass Memorial Medical Center: Three-Year Accreditation & Six Commendations
NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS (NAPBC) •
UMass Memorial Medical Center, Comprehensive Breast Center: Three-Year Accreditation
FOUNDATION FOR THE ACCREDITATION OF CELLULAR THERAPY (FACT) •
UMass Memorial Medical Center: Bone and Blood Marrow Transplant Program
EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY (ESMO) •
UMass Memorial Medical Center: Designated Center of Integrated Oncology and Palliative Care
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UMass Memorial HealthAlliance-Clinton Hospital 201 Highland Street, Clinton, MA Simonds-Sinon Regional Cancer Center UMass Memorial HealthAlliance-Clinton Hospital Burbank Campus 275 Nichols Road, Fitchburg, MA UMass Memorial Cancer Center at Marlborough Hospital 157 Union Street, Marlborough, MA UMass Memorial Medical Center Hahnemann Campus 281 Lincoln Street, Worcester, MA Memorial Campus 119 Belmont Street, Worcester, MA University Campus Ambulatory Care Center 55 Lake Avenue North, Worcester, MA HOPE Line – 866-597-HOPE (4673) www.umassmemorial.org/cancer
UMass Memorial Health Care is the largest not-for-profit health care system in Central Massachusetts with more than 13,000 employees and 1,700 physicians, many of whom are members of UMass Memorial Medical Group. Our member hospitals and entities include UMass Memorial HealthAlliance-Clinton Hospital, UMass Memorial – Marlborough Hospital, UMass Memorial Medical Center and UMass Memorial – Community Healthlink, our behavioral health agency. With our teaching and research partner, the University of Massachusetts Medical School, our extensive primary care network and our cancer, diabetes, heart and vascular, orthopedic and surgery programs, UMass Memorial delivers safe, highquality and compassionate care. Visit www.umassmemorialhealthcare.org. To find a physician in your community, call 855-UMASS-MD (855-862-7763).
MKTG 08/18