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SCCA Network News, Issue 6 Spring 2010

In this issue:

As it is with so many things come springtime, the SCCA Network is growing. This quarter, we welcome Bozeman Deaconess Hospital as our 9th SCCA Network member and look forward to working with them.

Also in this issue, you’ll learn about SCCA’s pain management program and endobronchial ultrasound, a specialized tool that helps diagnose lung conditions, including cancer, as well as the physician, Dr. Jason Chien, who works with EBUS at SCCA.

Around the Network, Multicare (Tacoma, Wash.) announced the opening of their new cancer center expansion project. Olympic Medical Center (Port Angeles, Wash.) welcomed Marian Johnson, clinical coordinator from SCCA Cancer Prevention Clinic at their booth at the KONP Home Show to talk about cancer prevention. And Providence Alaska Medical Cancer Center held an open house in late February that was attended by SCCA’s Jim Barker and Reza Macaraeg. The open house provided information on cancer prevention, treatment, research, and support groups at their cancer center. The Blood Bank of Alaska conducted a blood drive and bone marrow drive and the Alaska Heart Institute handed out information about the effects of radiation and chemotherapy on the heart. The highlight of activities for kids included visits with pet partner dogs. There were also mini health talks on a variety of topics, tours of the Providence Cancer Center, entertainment, refreshments, and an art exhibit.

Minimally Invasive Lung Biopsies

Early diagnosis and staging is the most important step toward definitive treatment for lung cancer. The pulmonologists at SCCA’s Lung Cancer Early Detection and Prevention Clinic (LCEDPC) now use a minimally invasive procedure called endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) in their array of approaches for diagnosing and staging lung cancer.

Prospective multicenter trials in patients with known or suspected lung cancer indicate that the sensitivity is generally higher than 90 percent. Among patients with lung cancer and a radiographically normal mediastinum (node size range, 5 to 10 mm), the sensitivity, specificity, and negative predictive values are 92.3, 100, and 96.3 percents respectively. When compared to patients with both negative CT scan findings and no detectable PET scan activity in the mediastinum, the reported sensitivity approaches 90 percent, and the study revealed an unexpected 9 percent prevalence of mediastinal metastasis, suggesting that EBUS-TBNA is a useful preoperative staging tool in all patients with lung cancer who are being considered for surgery.

EBUS-guided TBNAs have several advantages. Performed as an outpatient procedure, it requires only conscious sedation with a short recovery time. EBUS is able to reach more lymph node stations in the mediastinum, including the paratracheal and carinal nodal stations, and the hilar and subhilar stations. And, EBUS is associated with minimal adverse events. In the published literature, EBUS has been performed thousands of times with no serious complications reported. Because this is a minimally invasive approach, EBUS is the procedure of choice for patients who may have scar tissue in the mediastinum from previous surgery.

“This minimally invasive procedure has revolutionized the way pulmonologists approach mediastinal adenopathy and lung cancer,” says Dr. Jason Chien, director of the SCCA LCEDPC. Around the world, EBUS is rapidly replacing surgical mediastinoscopy as the preferred procedure for biopsy of mediastinal lymph nodes and staging of lung cancer.

If you would like more information on this procedure, or would like to have your patient evaluated for this procedure, please contact Donna Manders, LCEDPC coordinator, at (206) 288-7620.

SCCA Physician Profile: Jason Chien, MD, MS

Medical Oncologist

Dr. Jason Chien is a pulmonary and critical care specialist at Seattle Cancer Care Alliance and head of the Lung Cancer Early Detection and Prevention Clinic. He specializes in caring for lung problems in bone marrow transplant patients and in the prevention of tobacco-related diseases, in particular, lung cancer.

Dr. Chien is able to unify these two clinical areas in his research, which is focused on identifying genetic risk factors for lung-related diseases and developing statistical models that predict the risk of developing a specific outcome.

“In my laboratory, we use clinical, molecular, and genetic approaches to refine clinical definitions and search for genetic markers that may predispose an individual to developing these diseases,” he says.

For lung cancer, the problem of finding individuals at risk is more challenging. There are many investigations currently focused on finding these biomarkers by looking for protein and genetic changes in the blood that may reveal the early development of lung cancer.

Pain Management Program at SCCA

Medical statistics suggest that during the course of oncology care, 70 percent of patients will experience some form of pain which can limit their quality of life.

When medical oncologists at SCCA feel uncomfortable managing a patient’s pain, Dr. Dermot Fitzgibbon and his team at the SCCA Pain Clinic are there to receive consults or to manage a patient’s long-term pain care needs.

“We tend to be more involved in the more complex cases,” Fitzgibbon says. Cancer patients can experience chronic pain or tumor-related pain or combinations thereof.

Chronic pain remains relatively stable over time and can be managed by one or two doctors. In contrast, cancer pain however frequently changes, is complex, and involves many different care professionals.

“Cancer pain care needs to be carefully coordinated,” Fitzgibbon says. “More ‘interdisciplinary’ than ‘multidisciplinary,’ and requires careful follow-up of issues and medications that can complicate a patient’s overall care.”

There are 150 active Pain Clinic patients at SCCA. Their care team includes a nurse case manager, clinic oncology pharmacists, an advanced registered nurse practitioner (ARNP) who specializes in oncology pain, as well as Dr. Fitzgibbon, an anesthesiologist who specializes in pain management.

“We believe oncology patients’ clinical care is constantly changing. We offer a full scope of services,” says Fitzgibbon. “The majority of patients are managed by medications, but some get interventions; We coordinate home care with infusion services for these patients.”

Although the Pain Clinic does not accept outside referrals, they can provide assistance to network members that want to develop their own pain management programs. SCCA Pain Clinic providers are also available for clinic visits for CMEs or educational talks.

For more information about the Pain Clinic, contact Dr. Dermot Fitzgibbon at (206) 288-7222 or Dermot@seattlecca.org. To schedule a CME or talk at your clinic, contact the SCCA Network Office at (206) 288-1066 or sccanet@seattlecca.org.

Bozeman Deaconess Hospital

Bozeman Deaconess Hospital in Bozeman, Montana is the newest member of the Seattle Cancer Care Alliance Network—our ninth Northwest community health-care facility to join.

“We welcome Bozeman Deaconess and look forward to a productive affiliation that will benefit its cancer patients, physicians, and staff,” said Norm Hubbard, SCCA Executive Vice President.

Bozeman Deaconess Cancer Center cares for over 1,800 patients annually and offers comprehensive cancer care with state-of-the-art treatment systems. Their multidisciplinary team includes medical oncology/hematology and radiation oncology physicians, a nurse practitioner and physician assistant, oncology certified nurses and radiation therapists, a physicist, pharmacist, clinical laboratory technician, oncology social worker, breast care coordinator, and a financial case manager. Physicians hold weekly conferences with surgeons, radiologists, and pathologists to plan and coordinate patient care.

www.bozemandeaconess.org/cancercenter

Physician Profile: Jack Hensold, MD

Hematologist/Oncologist, Bozeman Deaconess Hospital

Jack Hensold, MD, is a board certified hematologist/oncologist at Bozeman Deaconess Hospital. He has been instrumental in the development of their new cancer center and their membership with the Seattle Cancer Care Alliance Network. Dr. Hensold has successfully lobbied the Montana state legislature for Montana’s Cancer Drug Donation Program. He frequently lectures on cancer-related topics and is working to expand oncology services to surrounding communities.

Dr. Hensold received his medical degree from Rush Medical College and fellowship training in hematology and medical oncology at Beth Israel Hospital and Harvard Medical School. He spent four years teaching at Harvard Medical School and was a visiting scientist at Massachusetts Institute of Technology. As associate professor of Medicine at Case Western Reserve School of Medicine in Cleveland, OH, Dr. Hensold taught, directed the fellowship training program in hematology and oncology, and ran an NIH-funded laboratory that investigated abnormalities of post-transcriptional regulation of gene expression in cancer cells.

MultiCare Regional Cancer Center

MultiCare’s Regional Cancer Center opened its brand new clinic building on March 1st in the new Milgard Pavilion at MultiCare Tacoma General Hospital.

Expanded to nearly three times the size of their previous cancer center, they now have capacity for 40 semi-private and private infusion chairs set up in pods of six that will accommodate individual preferences for social interaction or privacy. Thirty-three chairs are for chemotherapy, each with a personal entertainment system with television, radio, and Internet access. Many of the treatment rooms have sweeping views of the Tacoma skyline and Mount Rainier.

Radiation therapy services, located in the same building, include image-guided intensity modulated radiation therapy, HDR, brachytherapy, stereotactic cranial and body radiosurgery, and intraoperative radiotherapy. A CyberKnife robotic linear accelerator will be installed by summer 2010.

Patients will enjoy more space in clinic rooms and a large, enhanced resource center. Family members will enjoy larger waiting areas with play areas for children.

Four special patient navigators support the neuro-oncology, breast cancer, urologic oncology, and thoracic/lung cancer teams.

MultiCare offers a one-call referral program for scheduling. Over 8,300 staff care for patients at their four hospitals and several regional outpatient clinics, including pediatric oncology services at Mary Bridge Children’s Hospital. MultiCare Regional Cancer Center has been an SCCA Network member since January 2008.

www.multicare.org/home/cancer

Physician Profile: Umesh Chitaley, MD, MBBS

Medical Oncologist, MultiCare Regional Cancer Center

Dr. Umesh Chitaley is a board certified medical oncologist. He sees general oncology patients at Multicare Regional Cancer Center in Auburn and Tacoma General Hospital, but his main focus is breast cancer.

“My approach as a physician is to provide thoughtful, accurate, and insightful medical care, always keeping the patient at the center of the process,” Chitaley says.

Educated at Govt. Medical College in Nagpur, India, Dr. Chitaley received residency training in internal medicine at Northwestern University and hematology/oncology fellowship training at the Cleveland Clinic Foundation. He joined Tacoma General in 2009 after working in St. Cloud, Minn., where he was active in clinical research.

“It is important for patients to be able to access good clinical trials,” Chitaley says. He believes the SCCA Network relationship is good for patients for this very reason.

After office hours, Dr. Chitaley enjoys skiing, traveling, and hiking. He’s looking forward to exploring the Pacific Northwest.