In this issue

Issue No. 25 / May 2012

WITH THE HIRING OF TWO PROMINENT SCIENTISTS from the MD AndersonCancer Center, the Helen F. Graham Cancer Center enriches both the translational cancerresearch and medical physics programs.

Jennifer Sims-Mourtada, Ph.D., former director of Molecular Research and Development,at RadioMedix, Inc., in Houston and previously from the University of Texas MD AndersonCancer Center (UTMDACC), is the Helen F. Graham Cancer Center senior clinical scientistfor the Center for Translational Cancer Research (CTCR).

Her husband, Firas Mourtada, M.S.E., Ph.D., D. ABR, is the new chief of Clinical Physics inRadiation Oncology. Previously, Dr. Mourtada was a tenured associate professor in theDepartments of Radiation Physics and Experimental Diagnostic Imaging at UTMDACC. He retains an adjunct professorship with The University of Texas Graduate School ofBiomedical Sciences.

Helen F. Graham Cancer Centerhires pioneering scientific couple

Cancer Survivorship Program Helps Transition Patients to Life After Cancer

Genetic Testing Empowers Cancer Survivors

Collaboration with Wistar Institute to Develop Early Screening Tool for Lung Cancer

New Tool Helps Patients Evaluate Their Symptoms

Stephen Grubbs, M.D., Elected to Board of Directors of the American Society of Clinical Oncology

cancerupdate

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S C I E N T I S T S J O I N T H E H E L E N F . G R A H A M C A N C E R C E N T E R

2 Christiana Care Health System

Translational science

At the CTCR, Dr. Sims-Mourtada continues herpioneering work, investigating why some cancers areresistant to treatment and developing the imaging tools to target them for destruction.

“My goal is to find out which tumors would be resistantto treatment and which tumors are not likely to progressat all,” she says. The ability to characterize a patient’stumor in this way would provide important informationfor doctors to prescribe the most effective course oftreatment for individual patients.

Expert in radiation oncology physics

Dr. Firas Mourtada is an expert in radiotherapy physics,brachytherapy and dosimetry. He was on the faculty atUTMDACC since 2002. He holds several patents and haspublished and consulted extensively in the field ofradiation oncology physics, contributing to best practicestandards. As chief of Clinical Physics, he brings the unique perspective of a trained scientist as well as an experienced clinician to the Graham Centermultidisciplinary cancer care team. He and his staff ofdosimetrists and medical physicists, working with theentire radiation oncology team, play an important role inassuring accurate delivery of all aspects of the radiationtreatment prescription.

One of Dr. Mourtada’s goals is to develop a medicalphysics residency training program and master’s degreeprogram in medical physics at the Graham Center in thenext few years. “Our efforts to establish a medical physicseducation program coupled with our leadership in patientcare and research, I believe will solidify us as one of few,nationally recognized community hospital cancercenters,” he says.

All in the family

The Mourtadas’ passion for science brought them together13 years ago. Their partnership has inspired creativeapproaches to solve some of the thorniest scientificquestions about invading cancers and how to beat them.

Dr. Sims-Mourtada holds a Ph.D., in Biomedical Sciencesfrom the Department of Immunology at The University ofTexas Graduate School of Biomedical Sciences (2004). Herresearch on immune system genetics earned her a spot inthe prestigious journal, Nature.

At RadioMedix, Inc., (2006-2011), she built the companylab from the ground up and developed imaging agents for use with PET or CT scans. Under contract to the U.S.Defense Department, her group was the first to show thata radiolabeled protein called sonic hedgehog (named for a video game character) could differentiate stem cell-likebreast cancer cells from other tumor cells, and potentiallyidentify aggressive tumors. Her previous fellowshipresearch in experimental radiation oncology at UTMDACC(2004-2006) was among the first to link hedgehogexpression with resistance to radiation and chemotherapy.

Hedgehogs and tumor cells

“Given the successful tissue banking and procurementcapability here at the Helen F. Graham Cancer Center,”she says, “I want to use the imaging techniques I’vedeveloped to go back and look at multiple aggressivetumor types for the sonic hedgehog signature.”

Unlike his wife, who is a Texas native, Dr. Firas Mourtadacame from Syria. A new English speaker at 17, he studiedbiomedical engineering at Mercer University in Georgia.Upon graduation in 1992, he was one of 14 master’sdegree candidates funded by the Whitaker FoundationGraduate Fellowship at The Johns Hopkins University in Baltimore, where he stayed to complete a Ph.D., inRadiation Health (1997). After a one-year fellowship at the National Institute of Standards and Technology in Maryland, in 1998, he joined Guidant VascularInterventions Corp., a Fortune 100 biotech company inHouston, as senior medical physicist. Over the next twoyears, Dr. Mourtada and colleagues developed a numberof novel intravascular brachytherapy devices to treatcardiovascular disease.

At about this time, he met his future wife, Jennifer Sims. “I thought she was a brilliant scientist,” he recalls. Thecoupled married, and, in 2002, Dr. Mourtada joinedUTMDACC as an assistant professor in the Department of Radiation Physics. His biomedical engineering

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Their passion for science brought themtogether 13 years ago and they haveworked together on ways to solve someof the thorniest scientific questions aboutinvading cancers and how to beat them.

background and experience designing cardiovascularbrachytherapy devices led to new collaborations thatwould benefit his cancer patients.

One example of his innovative work is a novel applicatorfor cervical cancer brachytherapy, which is expected toreach market in 2013. An unlikely partnership withscientists from Los Alamos National Lab produced anadvanced dose calculation algorithm now used forplanning external beam radiation and brachytherapytreatments. Dr. Mourtada contends, “If we are to eradicatecancer, we need to find ways to work together across allscientific disciplines.”

While at UTMDACC, Dr. Mourtada also served as an advisor to RadioMedix, Inc., which affordedopportunities for the couple to work together. In 2011, the company earned support from the Texas EmergingTechnology Fund to launch a novel device developed andtested in Dr. Mourtada’s lab at UTMDACC to radiolabelpharmaceuticals for PET imaging. The device potentiallyenables users to generate and label PET radiotracers on-site at much lower cost than those produced by current Cyclotron technology.

Cancer Update 3

“My goal is to find out which tumorswould be resistant to treatment and whichtumors are not likely to progress at all.”

—Jennifer Sims-Mourtada, Ph.D.

“Our efforts to establish a medical physics education program coupledwith our leadership in patient care and research, I believe will solidify usas one of few, nationally recognized community hospital cancer centers.”

—Firas Mourtada, M.S.E., Ph.D., D. ABR

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MARILYNN RENZ COULD NOT SHAKE THE FEAR that her cancer might return some day.

“After my surgery and radiation treatments, I tried toconvince myself that I would be fine, but I wasn’t,” she says. “I was drifting in a lifeboat without an oar.”

Renz found her lifeline at the Helen F. Graham CancerCenter through its nationally recognized, multidisciplinaryCancer Survivorship Program.

Led by Scott Siegel, Ph.D., the Cancer SurvivorshipProgram and Survivorship Multidisciplinary Center helpsurvivors by focusing on the physical, psychological, socialand spiritual changes they can experience after cancer.

“For many patients, the post-treatment phase of cancer canbe even more challenging than their treatment,” Dr. Siegelsays. “Our studies and others nationally show that fear of recurrence is a top concern for almost every cancersurvivor.” The Graham Center’s Survivorship Program isat the forefront of behavioral research particularly in thisarea, which Dr. Siegel says resembles post-traumatic stressdisorder.

“I don’t know of any other program in the country thatemphases this strong psychosocial focus to survivorshipcare. Patients tell us they want and need help to managefear and anxiety just as much as medicine to relievetreatment side effects or physical symptoms.”

Essential patient follow up

Integral to the Survivorship Program is the patient’s post-treatment meeting with Clinical Nurse Specialist DarcyBurbage, RN, MSN, AOCN, CBCN. Her thorough patientassessment guides recommendations for psychologicalcounseling, symptom management, and a comprehensive

array of wellness programs, support groups and socialwork services. After about six weeks, Burbage meets withpatients again to assess progress and to provide a writtentreatment summary to share with their physicians.

“Part of my job is to help transition patients from activetreatment to life after cancer,” says Burbage, who wasrecognized in 2010 by the national Oncology NursingSociety for her creative leadership in patient care. “I’mhere to connect patients with the services they need, toanswer their questions and sometimes, just listen.”

Multidisciplinary approach

In the aftermath of her breast cancer, Renz had multipleconcerns, so Burbage recommended the Graham Center’s Survivorship Multidisciplinary Center. At theSurvivorship MDC, providers from multiple specialties,including Dr. Siegel and Clinical Nurse Specialist andwellness coach Cindy Waddington, RN, MSN, AOCN, satdown together with Renz to devise a customized care plan.

Cancer Care Connections Director Janet Teixeira, LCSW,was a helpful link to resources in the community, andEllyn Hutton, RN, a licensed massage therapist andcertified yoga instructor, provided mind-body techniquesand integrative medicine approaches.

“I left that first meeting feeling that there might be hopefor me,” Renz recalls. “Since then, Dr. Siegel has helped me work through my fears and build up confidence that I could beat this thing. He also suggested a communitysupport group, which I look forward to every week.”

Social worker Michelle Bailiff, LCSW, addressed concernsabout insurance and with dietician, Elena Schumacher,RD, CSO, devised a nutrition and wellness plan thathelped Renz drop some unwanted weight and control hotflashes caused by her medication. She continues to benefitfrom meditation and the exercise programs offered at theGraham Center through the Mind, Body, Spirit WellnessProgram and is a frequent visitor to the Cancer ResourceLibrary.

“The Cancer Survivorship Program put my life backtogether again,” says Renz. “Everyone should know there ishelp out there. You don’t have to face life after cancer alone.”

Established in 2006, the CancerSurvivorship Program hastouched the lives of thousands of survivors and has been recognizedas one-of-a-kind in multipleprofessional publications.

Cancer Survivorship Programhelps Newark woman embracelife after breast cancer

Darcy Burbage, RN, MSN, AOCN, CBCN, Cindy Waddington, RN,MSN, AOCN with patient Marilynn Renz.

Cancer Update 5

EBUS procedure

DOCTORS DIAGNOSED KATHRYN BENDER-JONES WITH BREAST CANCER AT 49. The FamilialCancer Genetic Risk Assessment Program at the Helen F.Graham Cancer Center gave her the information sheneeded to make an informed and confident decision abouther medical care.

“There is so much cancer in my extended family,” Bender-Jones says. “When I found out I had breast cancer,I felt there had to be a connection.”

Genetic testing at the Graham Center confirmed forBender-Jones that she carries a BRCA2 gene mutationlinked to hereditary breast and ovarian cancer. For womenwho carry such a mutation, the odds of developing breastcancer are five times greater than for someone who doesn’t have the mutation. BRCA2 mutations can alsoincrease the risk of developing other cancers.

“Having that information empowered me to be moreproactive about my own care,” she says.

According to Zohra Ali Khan-Catts, MS, CGC, director of Cancer Genetic Counseling, “Genetic testing won’t tellus when a person might get cancer, but it can tell us who isat greater risk due to hereditary factors.”

An important first step is taking a comprehensive personaland family medical history. “From the family cancer riskassessment we can identify whether genetic testing isavailable and if there is a clinical or research study ofpotential benefit,” Ali Khan-Catts says. “Armed with thisinformation, we can offer patients the best possibleinformation about screening and options for cancer riskreduction and early detection.”

Patients also have the opportunity to participate in theHigh Risk Family Cancer Registry, which now documents3,175 families and 143,773 individuals from Delaware and neighboring states who either have cancer or are at high risk for developing the disease. These data areincorporated into a comprehensive database of familyhistories that in many cases extend back generations.

The Registry is an important resource for genetic scienceand epidemiological (population-based) studies, such asthose underway at the Center for Translational CancerResearch on breast, colon and endometrial cancer.

Donna Harris had no idea that her breast cancer andrecurrent uterine tumors were related. “My experiencewith the genetic risk assessment team answered a lot ofquestions that for years made my doctors just throw uptheir hands.” She was relieved to find out she did not haveheredity breast cancer and that she could join a researchstudy on Cowden syndrome, a possible risk factor forbenign and cancerous tumors.

“I would have driven anywhere to get the best medicalcare, but at the Cancer Center I didn’t have to go far. All ofmy care providers worked well as a team, all in one place,and to me that made all the difference.”

“Genetic testing won’t tell us whena person might get cancer, but it cantell us who is at greater risk due to

hereditary factors.”

—Zohra Ali Khan-Catts, MS, CGCDirector of Cancer Genetic Counseling

To speak with a genetic counselor, call the Family CancerGenetic Risk Assessment Program at 302-623-4593.

Cancer survivors say genetic testing can empower us

Genetic Counselor Becky Milewskiwith patient Donna Harris.

Patient Kathryn Bender-Jones with Genetic Counselor Marcie Parker.

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CLINICIANS AT THE HELEN F. GRAHAMCANCER CENTER join scientists at The WistarInstitute and Temple University to develop the world’sfirst practical blood test for lung cancer. A $1 milliongrant to fund the project for two years comes fromPennsylvania’s Commonwealth Universal ResearchEnhancement (CURE) Program.

“Collaborating with Wistarscientists to develop an earlyscreening tool for lung cancer is acompelling example of ourtranslational cancer research effort,”says Nicholas J. Petrelli, M.D.,Bank of America endowed medicaldirector of the Helen F. GrahamCancer Center. “Our historicpartnership with Wistar to speeddiscoveries from their labs to clinicaltrials will benefit patients at theGraham Center and elsewhere, andthis project is an important first step.”

Lung cancer is the most common cause of cancer-related deaths in Delaware and the nation. Right now,there are no clinically effective ways to screen for anddetect lung cancer at an early stage when it might becurable. But that is about to change.

Recently, Louise C. Showe, Ph.D., a professor inWistar’s Molecular & Cellular Oncology program and director of Wistar’s genomics facility, showed it is possible to detect early stage non-small cell lungcancer (NSCLC) by examining changes in gene activityin white blood cells, important to the body’s immunesystem. By partnering with the Helen F. Graham Cancer Center and Temple University Health System, Dr. Showe aims to streamline blood collection and analysis to develop a commercially viable test for NSCLC.

According to Thomas Bauer, II, M.D., chief of ThoracicSurgery, “Our ability at the Graham Center to recruit

large numbers of patientvolunteers to provide bloodsamples in the quantitiesneeded for analysis is criticalto take Dr. Showe’s concept to clinical trials.”

“With a simple blood draw,”says Dr. Showe, “we can detect lung cancer, show the effectiveness of cancersurgery, by sampling the same

patient’s blood for analysis after surgery, and hopefullyeven determine if the cancer may return.”

Dr. Showe and her colleagues at Wistar first discoveredthe link between NSCLC and white blood cell genechanges in 2009. Two years later, the researchers foundthat gene expression patterns change when a tumor isremoved and could return to normal after successfullung cancer surgery. They showed further that certaingenes distinguish between malignant tumors and non-malignant lung nodules, suggesting that a blood testcould guide treatment decisions and potentiallyprevent unnecessary surgeries.

Helen F. Graham Cancer Center shares $1 million grant with Wistarand Temple to develop world’s first blood test for lung cancer

“With a simple blood draw, we can detect lung cancer,show the effectiveness of cancer surgery, by sampling the same patient’s blood for analysis after surgery, andhopefully even determine if the cancer may return.”

—Louise C. Showe, Ph.D.Wistar Institute

Thomas L. Bauer, II, M.D.

Nicholas J. Petrelli, M.D.

Working on the front line to welcome new patients

Cancer Care Management Access Coordinators Michele Dailey and Lori Maugle work as a team to welcome patients to the Helen F.Graham Cancer Center. “We consider ourselves the ‘front line,’”Dailey says. “We are often the patient’s first point of contact whencoming to meet with their multidisciplinary cancer team. What’simportant is the patient I am going to make smile today.”

“Our patients expect and deserve great care,” Maugle adds. “It takes all of us working as a team to achieve that. This is the place where their healing begins.”

FEATURED EMPLOYEES

Cancer Update 7

CHRISTIANA CARE WON A 2012 LAUREATE AWARD fromInternational Data Group’s Computerworld Honors Program forcreating a unique self-assessment tool that helps patients evaluatetheir symptoms.

Each year, Computerworld honors visionary companies who applyinformation technology toward positive social, economic andeducational change. Christiana Care’s collaboration of clinical andInformation Technology staff won in the health category, one of 10 classifications that in total received more than 500 nominations.

Christiana Care’s winning software program, called Insight, enablespatients to use a tablet-based, clinician-friendly wireless format toreport the severity of their symptoms and affect on quality of life.Cancer patients first used the tool in a pilot program in May 2010followed by heart failure patients. Their feedback helped developthe program.

“Insight makes it easier for the patient and the doctor to have aconversation about more sensitive issues or symptoms they mightnot otherwise volunteer,” says Theresa Gillis, M.D.,medicaldirector of Oncology Pain and Symptom Management andRehabilitation Services at the Helen F. Graham Cancer Center. “Thepatients’ ratings give ‘insight’ into their distress, their function andindependence and their well-being. Patients seem more comfortablediscussing feelings of anxiety and depression after using this tool.”

Seventy-six percent of patients report they like using Insight, with67 percent claiming the tool better prepares them to speak withtheir doctor. Christiana Care’s Information Technology team islaunching a new release this year for a wider patient audience foruse with an Apple iPad.

Cancer patients pilot award-winningsoftware honored by Computerworld

Lori Maugle and Michele Dailey

“Insight makes it easier for the patient and the doctor to have aconversation about more sensitive issues or symptoms they might

not otherwise volunteer.” —Theresa Gillis, M.D.

Medical Director of Oncology Pain and Symptom Management and Rehabilitation Services

Theresa Gillis, M.D., reviews the features of Insight with a patient.

Cancer Update is produced by Christiana Care Health System. Entire publication © Christiana Care Health System, 2012. All rights reserved. 12CANC88

Christiana Care is a private not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill itsmission. To learn more about how you can support our mission, please visit www.christianacare.org/donors.

P.O. Box 1668Wilmington, Delaware 19899www.christianacare.org

One of the original 14 cancer centersin the nation selected for the

National Cancer Institute CommunityCancer Centers Program.

Non-Profit Org.US Postage

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8 Christiana Care Health System

Christiana Care Medical Oncologist Stephen S. Grubbs, M.D.,begins a three-year term, starting June 1, 2012, on the board ofdirectors of the American Society of Clinical Oncology (ASCO),the world’s leading professional organization representingphysicians who care for people with cancer.

As managing partner of Medical Oncology Hematology Consultantslocated at Christiana Care’s Helen F. Graham Cancer Center, Dr. Grubbsbrings a “community oncologist” perspective to ASCO deliberations. Anaccomplished researcher and author, Dr. Grubbs also serves as principalinvestigator for Christiana Care’s Community Clinical Oncology Programand on the board and executive committee of the Alliance of Clinical Trialsin Oncology, which, through the National Cancer Institute, speeds thelatest cancer control, prevention and treatment clinical trials to patients at community cancer centers.

MU LT I D I S C I P L I N A R Y C A N C E R C E N T E R S A T T H E H E L E N F . G R A H A M C A N C E R C E N T E R

• Lung / CyberKnife• Neuro / CyberKnife• Breast Cancer• Genetic Risk Assessment• Genitourinary Cancer• Head & Neck Cancer• Hepatobiliary / Pancreatic Cancers• Hepatoma Screening

Stephen Grubbs, M.D., elected to ASCO board

• Lymphoma• Melanoma / Soft Tissue & Bone Sarcoma• Mind, Body & Spirit Wellness• Rectal / Anus Cancers• Pain & Symptom Management• Thoracic / Esophageal Cancers• Young Adult Follow-up• Survivorship