Healing SpiritA newsletter for those affected by cancer

New procedure offers hope to cancer patients

Terry Carver first met medical oncologist, Steven Dunder, MD, in the summer of 2012. At that time, he was newly diagnosed with hepatocellular carcinoma (liver cancer). Terry underwent surgery to remove the cancer and was doing well until the summer of 2014 when the cancer returned.

Too often cancer patients are told that there are no treatments left to consider when they have liver cancer or the cancer has spread to the liver, leaving the prognosis grim. CHI Health St. Elizabeth is excited to provide an innovative approach to attacking metastatic liver tumors, with a procedure known as Selective Internal Radiation Therapy (SIRT).

During SIRT, interventional radiologists at St. Elizabeth, Eric Vander Woude, MD, and Raul Razdan, MD, inject millions of tiny radioactive beads directly into the blood vessels that feed the liver tumors. The beads block blood flow to the tumors while delivering powerful doses of radiation — all without harming adjacent healthy tissue.

“SIRT is a minimally invasive way of delivering radiation directly to the tumors, allowing us to stop their growth and, in some cases, shrink them,” says Dr. Razdan.

As part of a routine follow-up appointment with Dr. Dunder, Terry had a MRI completed of his liver. “I remember sitting at my desk, looking at the MRI report showing that the cancer had come back in several places within the liver. Surgery was no longer an option. Chemotherapy options for this disease are limited and do not offer significant increases in survival. While looking at Terry’s chart, I saw his birthday was six months away. I had to go give him news of the cancer’s return, knowing that conventional treatments offered about a

50 percent chance of letting him celebrate his next birthday. It was right around this time that the team here in Lincoln was getting the SIRT program up and running. I asked Dr. Razdan to look at Terry and his MRI to see if he’d be a good candidate for the procedure.”

Advanced Image Guidance

Key to the success of SIRT is DynaCT, which was purchased with funds from the St. Elizabeth Foundation, a new imaging system that provides real-time, three-dimensional images of the liver anatomy and surrounding vasculature before and during the procedure.

“DynaCT imaging allows us to pinpoint tumors and blood vessels,” Dr. Razdan says. “It can be used for SIRT as well as other types of procedures that require precise placement of needles and catheters, such as chemoembolization, which delivers chemotherapy drugs into the tumor-feeding blood vessels.”

Front row, left to right - Dr. Steven Dunder, Terry Carver; second row, left to right - Dr. Eric Vander Woude, Dr. Rahul Razdan

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Dr. Vander Woude, calls this new treatment a game changer. “If a patient is faced with metastatic cancer in the liver, we can treat that lesion, which will keep it from getting bigger and spreading to other parts of the body. Now, in some instances where it is primary cancer of the liver, this procedure has been shown to cure the cancer.”

How it Works

About a week before the SIRT procedure, patients undergo a planning procedure. Using the DynaCT system, radiologists map the location of the tumors and block off certain blood vessels to prevent the radioactive beads from migrating outside the liver.

The procedure itself takes about two hours and is done under anesthesia. Using the previously mapped images along with real-time DynaCT guidance, radiologists guide a catheter from the groin through the body until they reach the liver tumors’ primary blood supply.

They then inject the radioactive beads, or microspheres (yttrium-90 or Y-90). The microspheres themselves are about five times the diameter of a red blood cell.

Terry, as with most patients, was able to leave the hospital that same day. “I would highly recommend the SIRT procedure to anyone. I didn’t experience any pain,” Terry said. “Another great benefit to the procedure is that even after the patient goes home, the microspheres continue to deliver radiation to the tumor,” Dr. Razdan said.

Giving Patients a Reason for Hope

Dr. Dunder added, “As a medical oncologist, we always want more treatment options for our patients. This option offers hope. It has quite limited toxicity. And, I can tell my patients that they don’t have to travel far away to a large health care system in an unfamiliar city. This technology and expertise is right here in Lincoln.”

This technology provides an innovative new treatment option for many patients. “Dr. Razdan and I, along with St. Elizabeth, are proud to be the first to offer this targeted treatment in Lincoln. SIRT is improving our patients’ lives,” Dr. Vander Woude said. “It is one more example of how we are dedicated to building a premier cancer center.”

Dr. Dunder reinforces how beneficial this procedure is to his patients. “Terry just celebrated his birthday. If you see him, you wouldn’t know he has such a bad disease,” he said. “Also, if you saw him, I bet he shared a joke and a smile with you. With that said, there’s no doubt that Terry has benefitted.”

Terry recently celebrated his 71st birthday and is looking forward to attending two of his grandchildren’s high school graduations later this year. “If it adds two months or five years, it is worth it,” Carver said.

For more information on St. Elizabeth’s Commission on Cancer Annual Report, please visit: http://www.chihealthstelizabeth.com/commissiononcancer

New procedure offers hope to cancer patientsContinued from cover

“This option offers hope ... patients don’t have to travel far away to a large health care system in an unfamiliar city. The technology and expertise is right here in Lincoln.”

- Dr. Steven Dunder, Medical Oncologist

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When you work or play outdoors, it’s easy to forget about protecting your skin from the sun. The sun’s ultraviolet (UV) rays can damage unprotected skin in as little as 15 minutes. Tanning beds also cause UV damage to your skin. If you are sunburned or suntanned, your skin is damaged — it does not make any difference whether it came from the sun or from a tanning bed.

Skin damage from UV rays results in premature skin aging, and that damage may make us look older than we should. While no one wants to look older, serious skin damage can occur that results in skin cancer. Each year more than five million people are treated for skin cancer in the United States. The annual

cost of treating these skin cancers is estimated at $4.8 billion for non-melanoma skin cancers and $3.3 billion for melanoma skin cancers.

Most skin cancers are nonmelanomas. Non-melanoma skin cancers can, but usually do not result in death. If they are allowed to grow, removal of these skin cancers can cause significant scarring. There are two common types of nonmelanoma skin cancers: Basal cell skin cancer and squamous cell skin cancer. Basal cell skin cancers are the most common. While squamous cell skin cancers are the second most common, there has been a rise in the number of cases being diagnosed. About two percent of people with squamous cell skin cancer die from the disease.

The most dangerous skin cancer is melanoma. Melanoma has the ability to spread from where it started to other parts of the body. It was estimated that more than 9,700 people would die from melanoma in the United States in 2014. The incidence of melanoma is rising, and it is the most common form of cancer in young people between the ages of 15 and 29. Most melanoma is attributed to UV ray exposure.

Warning signs of melanoma include a change in the size, shape or color of a mole. Be alert for new suspicious looking growths on the skin or a sore that doesn’t heal. Risk factors for melanoma include family history of melanoma, or many large moles called dysplastic nevi that are irregularly shaped. Additional risk factors include a history of excessive sun exposure, sunburns or use of tanning beds.

So, if it’s summer or winter, if it’s cool and cloudy, you still need skin protection. UV rays, not the temperature, cause the damage. Clouds do not block UV rays; they filter them — and sometimes only slightly. Remember to plan ahead, and keep sun protection handy in your car, bag, or child’s backpack.

Protect yourself from skin cancer by using sunscreen with a Sun Protection Factor (SPF) of 15 or higher that provides both UVA and UVB protection. Apply at least one ounce of sunscreen (about the size of a golf ball) to your body 30 minutes before you go outside. Reapply every two hours or after swimming or excessive sweating. Wear sunglasses that block as close to 100 percent of both UVA and UVB rays as possible. Wear a hat with a wide brim to shade your face, head, ears and neck, and sun-protective clothing. Seek shade, especially during midday hours. Cover up with clothing to protect exposed skin. Avoid tanning beds and sunlamps. Seek medical care if you discover new and suspicious changes in your skin or a mole.

This information was gathered from the CDC at: http://www.cdc.gov/Features/SkinCancer/, The Skin Cancer Foundation at http://www.skincancer.org and the American Cancer Society’s Cancer Facts and Figures 2014.

Protect your skin

If I use a sunscreen witha high SPF, I’m all set.

A sunscreen with SPF of 15 or higher is im-portant, but you also need a “broad spec-trum” product that protects against both types of harmful rays, UVA and UVB. SPF sunscreen provides protection from UVB rays. To protect against UVA rays, look for a combination of the following ingredients: zinc oxide, titanium dioxide, oxybenzone, avobenzone, and Mexoryl™ SX.

You don’t have to be veryold to get skin cancer.

25 percent of people with melanoma are under the age of 40, and for women be-tween 25-29 years of age, melanoma is the most common form of cancer.

Just one or two severe sunburns during your childhood increases your risk of melanoma.

More than 90 percent of all skin cancers are caused by too much sun exposure. It only takes two severe sunburns as a child to double your risk for melanoma later in life.

Fact or Fiction?

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Approximately 5-10 percent of all colorectal cancers are caused by inherited cancer syndromes. Families with inherited cancer syndromes often have early onset cancers, usually under age 50, with multiple relatives affected. Individuals with an inherited cancer syndrome may have multiple cancers in their lifetime. Inherited colorectal cancer syndromes should also be considered in individuals with a history of multiple colon polyps.

The most common colon cancer syndrome is Lynch syndrome. Individuals with Lynch syndrome have up to a 75 percent lifetime risk of developing colon cancer. Also, women with Lynch syndrome have up to a 60 percent risk of developing uterine cancer. Some families or individuals can also have ovarian, stomach, small bowel, brain, urinary tract, and/or skin cancers.

The second most common colon cancer syndrome is Familial Adenomatous Polyposis (FAP). Individuals with FAP have up a 100 percent lifetime risk to develop colon cancer if left untreated. The main feature is the presence of 10 to 100s of colon polyps, mainly adenomas. The age of onset for polyps is typically in the teens, but may be later in life in some families. There is an increased risk for cancer of the thyroid, stomach, small bowel, and specific-liver tumors in children called hepatoblastomas.

Both Lynch syndrome and Familial Adenomatous Polyposis are inherited cancer syndromes caused by mutations in certain genes. Genes are the instructions that tell our bodies how to grow and function. Both of these syndromes are inherited in an autosomal

dominant fashion. A mutation is only needed in one copy of the gene in order for the inherited predisposition for cancer to occur. An individual carrying a mutation has a 50 percent chance of passing the mutation on to each of their children. The mutation can be passed down by both mothers and fathers. However, about one-third of individuals with FAP have a new mutation, thus they will have no family history. Genetic testing is currently available for both Lynch syndrome and FAP. There are also less common colon cancer syndromes which currently have genetic testing available.

There are options available for cancer screening including increased and earlier cancer surveillance as well as preventative surgery. A genetic counselor can help guide patients through the genetic testing process and help understand their individual cancer risks. Genetic counselors, along with physicians, help to create a screening plan for each individual.

As part of our commitment to cancer care, CHI Health offers our genetic counseling service at no charge to the patient or insurance company. Genetic testing is typically covered by insurance and most patients pay $100 or less out of pocket. Medicare typically pays 100 percent of test costs in cases of high risk. In some cases, testing may be available at no cost to those without health insurance.

Resources• Aarnio M et al. Cancer risk in mutation carriers of

DNA-mismatch-repair genes. Int J Cancer 1999• Lindor NM et al. Concise handbook of familial

cancer susceptibility syndromes, second edition. Journal of the National Cancer Institute Monographs, No. 38, 2008

Hereditary colon cancer

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Healthy living during and after cancer treatmentCancer survivors often ask questions about food choices, physical activity and dietary supplements. They want to learn whether nutrition and physical activity can help them to live longer or feel better. These guidelines are meant to answer some of those questions. Developed by an American Cancer Society (ACS) panel of experts, they will give you as a cancer survivor and your family the information you need to make informed decisions about your food and physical activity choices.

Exercise during cancer treatment

Exercise is safe during cancer treatment, and is has many benefits. It improves bone health, muscle strength, erectile dysfunction, and other quality of life measures. Before starting your exercise program, talk with your doctor or health care team. Ask them about when you can start to exercise and how you can be physically active during treatment. Your health care team will

consider your condition and your personal preferences as they help you work out a plan.

If you are receiving chemotherapy and/or radiation therapy and already have an exercise program, you may need to exercise at a lower intensity and/or for a shorter period of time for a while. The goal should be to be active as much as possible. Some doctors may suggest that you wait to see what side effects you have with chemotherapy before starting physical activity.

If you did not exercise before your diagnosis, you might start with low-intensity activities such as stretching and brief, slow walks and progress slowly.

Older adults and those with bone metastases, osteoporosis, arthritis, or peripheral neuropathies should pay careful attention to their balance and safety to reduce the risk of falls and injuries. Having a caregiver or exercise

professional present during exercise sessions can be helpful.

If you are unable to exercise, you might ask about physical therapy. Physical therapy during bed rest will help to maintain strength and range of motion and can reduce fatigue and depression.

Recovery after treatment

After you have finished your treatment, you may still have symptoms or side effects that affect your nutrition and physical well-being. It will take some time for them to go away. If you lost weight during treatment, nutrition counseling will help you regain a normal, healthy weight. If you are overweight or obese, counseling can help you achieve a healthy weight. You may also need treatment for other symptoms or side effects that have not gone away. After treatment, a program of regular physical activity will help you recover from treatment and will improve your fitness.

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Radiotherapy plays an important role in cancer management. In recent years, treatment goals have shifted from life preservation to cure while maintaining quality of life.

One type of radiotherapy, called brachytherapy, involves a physician placing a radiation source internally, either into or immediately adjacent to the tumor. This allows precise dose delivery and better spares surrounding healthy tissues. For early stage breast cancer patients planning to receive treatment at CHI Health St. Francis, placement of the treatment apparatus currently is being performed by Dr. Brant Luebbe of the Surgery Group of Grand Island. The process typically takes place a few days before patients begin the actual treatments.

Cancer Treatment Center patient Velma Cain recently underwent treatment for early stage breast cancer and chose brachytherapy for the minimal treatment time and because her physicians thought it would be a good choice for someone with her characteristics.

Dr. Doug Clark, the radiation oncologist at St. Francis, is excited to offer this technology at the Cancer Treatment Center. “High-dose rate brachytherapy offers patients with certain cancers a treatment option that is much shorter and more convenient than conventional external beam radiation treatment,” Clark said. “A typical course of brachytherapy is completed in five days or less, compared to multiple weeks of conventional external beam radiation therapy. Patients also experience minimal side effects and have minimal recovery time.”

Cain, who is 74, said the short treatment time was a necessity for her. A daily three-hour round trip for nearly two months would not have been feasible for Cain and her husband, who live in Burwell. Instead, she opted for the brachytherapy treatment and a week-long stay at the St. Francis guest house.

Patient Shirley Sewill was in a similar situation. Living in Sargent and not having extra assistance due to another illness in the family, Sewill was thankful that her early stage breast cancer qualified her for brachytherapy.

“The short treatment time and availability of the guest house was perfect for someone like me who can’t drive to Grand Island every day for treatment,” Sewill said.

Sewill said that aside from some minor discomfort at the treatment site, everything went smoothly. “Both Dr. Luebbe’s staff and the Cancer Treatment Center staff were wonderful. I would recommend this treatment to any woman who qualifies.”

Cain said although the placement of the apparatus at her tumor site was at first “a little scary,” she quickly got comfortable with it. The short treatment time also made her experience less stressful.

“The first radiation treatment took a little bit longer because of the set-up, but after that it was 15 minutes twice a day for five days. It was no big deal, and I’m not going to lose my hair,” Cain said with a smile.

“It’s wonderful to have services like this in Grand Island. We are so happy with the fellowship and friendship we experienced during our stay. The Imaging Center did a very thorough job and all the nurses who worked with us at the Cancer Treatment Center were fantastic.”

High-dose rate brachytherapy can be used in conjunction with other treatments like chemotherapy, or as an alternative, stand-alone option for the treatment of numerous types of cancers, such as breast, gynecologic, lung and esophageal cancers.

Brachytherapy is also available at Good Samaritan Cancer Center in Kearney and St. Elizabeth Cancer Institute in Lincoln. To learn more about what types of patients are right for this therapy, please contact St. Francis Cancer Treatment Center at (308) 398-5450, Good Samaritan at (308) 865-7985, or St. Elizabeth at (402) 219-5000.

Dr. Doug Clark demostrates a brachytherapy treatment

St. Francis Cancer Treatment Center expands radiation treatment options with brachytherapy

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In the CommunityA look at the upcoming events in your area

SPECIAL EVENTS

Good Samaritan:

• Cancer Survivors Day, 6 p.m. on Thursday, April 9, First United Methodist Church Fellowship Hall. Call (308) 865-7985 to register.

• Colorectal Cancer Screenings, March 2-20. Call (308) 865-7884 or (800) 658-5169 to obtain a free kit.

St. Francis:

• A free community health screening clinic will be held at the Grand Island YWCA in April at a date to be determined. Screenings include clinical breast exams, cholesterol, glucose, blood pressure, HIV, along with nutritional counseling, tobacco cessation and much more. Call Connie at (308) 398-3218 for more information.

St. Elizabeth:

• St. Elizabeth is hosting “Take the Pledge: Colon Cancer Awareness and Survivorship Event” on Thursday, March 5. The evening will kick off at 5:30 with a social mixer and light dinner, followed by the Take the Pledge Kickoff at 6 p.m. Survivors will be honored at 7 p.m. Speakers and topics include: Dr. Reggie Thomas, Gastroenterologist – Importance of taking the pledge; Dr. Michael Jobst, Colorectal Surgeon – Innovations in colon cancer treatment; Jon Bruning, Former Nebraska Attorney General – A conversation can save your life. Call (402) 219-7000 or visit CHIHealthStElizabeth.com to register for this event.

ONGOING MONTHLY PROGRAMS

Good Samaritan:

• Breast Cancer Support Group meets the second Tuesday of the month at the Good Samaritan Cancer Center.

• Leukemia and Lymphoma Society Telephone Support Group meets the second Tuesday of each month at 10 a.m. Participants call in from the privacy of their home. Call Julia Cañas, Patient Access Manager - Nebraska Chapter The Leukemia & Lymphoma Society at Office: (402) 344-2242 or toll free: (888) 847-4974

• Look Good … Feel Better meets the third Monday of each month from 10-11:30 a.m. Participants must register. To register call CHI Health Good Samaritan at (308) 865-7985.

• The United Ostomy Group continues to meet on the first Sunday of every month at 1 p.m. at CHI Health Good Samaritan Conference Center. Call Shirley Larson at (308) 390-5752 or Cindy Dennis at (308) 238-1111 for more information.

St. Elizabeth:

• Breast Cancer Support Group meets the first Wednesday of the month in the waiting room of the Radiation Therapy Center from 7-8:30 p.m.

• Cancer Related Brain Fog - Some call it “chemo fog,” or “chemo brain.” Some call it a nuisance; others call it incapacitating. This “chemo fog” following cancer diagnosis can cause a loss of clarity that is both frustrating and life altering. This class is taught in an informative, fun and interactive way that can help you improve the way you think, feel and function after chemotherapy. Participants meet for 1.5 hours a week for eight weeks in a group setting. Call (402) 219-7284 for more information.

St. Francis:

• The Multiple Myeloma Support Group provides support, education and caring for those diagnosed and their family members. Group members meet the third Wednesday of each month at 10 a.m. at Evangelical Free Church, 2609 S. Blaine St., in Grand Island. For information, please contact Arlene Preisendorf, (308) 380-8526, or Dr. Jim Omel, (308) 381-0289.

• Tobacco cessation classes - The American Lung Association’s Freedom From Smoking® classes are available to anyone in the community interested in quitting tobacco products. Meeting with a small group ensures personal attention from the facilitator and provides support from others who are in the same situation. To sign up or learn more, call Ann Tvrdy or Connie Hameloth at the Cancer Treatment Center, (308) 398-5450.

Disease-free living or living with stable disease

Setting and achieving goals for weight management, a physically active lifestyle, and a healthy diet will benefit your overall health and quality of life. To help you with these goals, the ACS has developed guidelines in three areas: weight management, physical activity and dietary patterns. Following these guidelines may help to reduce the risk of cancer recurrence and of developing another cancer. They are also important for your heart health.

Get to and stay at a healthy weight.• If you are overweight or obese,

limit your intake of high-calorie foods and beverages and increase physical activity to promote weight loss.

Be active.• Avoid inactivity and return to

normal daily activities as soon as possible after diagnosis.

• Aim to exercise at least 150 minutes per week.

• Include strength training exercises at least two days per week.

Eat a variety of healthy foods from plant sources.• Limit the amount of processed

meat and red meat you eat.• Eat 2 ½ cups or more of

vegetables and fruits each day.• Choose whole grains rather than

refined grain products.

For more information on the ACS’s Nutrition and Physical Activity Guidelines for cancer prevention or for cancer survivors, please call 1-800-227-2345.

Good Samaritan, St. Elizabeth and St. Francis also have physical therapy specialists who can help you determine what level of exercise is right for you.

Source: Excerpt from cacancerjournal.com, “Nutrition and Physical Activity Guidelines for Cancer Survivors”

Healthy living during and after cancer treatmentContinued from page 5

If you have questions or comments about this newsletter, or would like to unsubscribe, please contact Erin Martinez at emartinez@sfmc-gi.org or (308) 398-6787.

Healing SpiritA newsletter for those affected by cancer

St. FrancisCHIHealthStFrancis.org2620 West Faidley Avenue

Grand Island, NE 68803(308) 384-4600

St. ElizabethCHIHealthStElizabeth.com

555 South 70th StreetLincoln, NE 68510

(402) 219-8000

Good SamaritanGSHS.org

10 East 31st StreetKearney, NE 68847

(308) 865-7100