THE MANY FACES OF THE AUGUSTA HEALTH TEAM

TOGETHER WE CAN

2017 CANCER PROGRAM ANNUAL REPORTBased on 2016 Outcomes

A Message from Leadership 2

Tumor Board 3

Statistical Review 4

Clinical Case Study 5

Margaret’s Story 6

Faces of Augusta Health Cancer Care 8

DukeHealth 10

A Triple Threat AgainstLung Disease 11

TABLE OF CONTENTS

• Oursurgicalteam,whoproviderobotictechniquesusingthedaVincisystemwhichallowsfasterrecovery,a shorter hospital stay and fewer complications over traditional intervention.

• Oursubspecialtytrainedpathologistswhohaveaccess to all current molecular assays in the evaluation of tumor markers that may respond to targeted/personalized therapy.

• Oursupportstaff,whoworktoensureaccessto providers with a streamlined delivery of care and enrollment in clinical trials. Evolution to a consolidated medical records system is progressing sorecordswillbeavailable24/7toallhealthcareproviders participating in a patient’s care.

AsaDukeHealthaffiliateincancer,themanyfacesoftheAugustaHealthCancerProgramextendbeyondourwalls.Weoptimizeonlinevideoconferencing,geneticcounselingopportunitiesandavailabilitytoclinicaltrialsas part of this advanced network.

TheAugustaHealthCancerProgramisaccreditedbythenationally recognized Commission on Cancer and is one of only seven recognized as a Breast Imaging Center of ExcellenceinthestateofVirginiabytheAmericanCollegeof Radiology.

Wewelcomeyourreviewofourannualreport,andenjoyits comprehensive presentation of the programs and services we provide. It reflects the work of an entire hospitalstaffanditsadministration—theManyFacesofthe Augusta Health Team.

Cancerisnotonedisease.Itismanydiseases,eachasuniqueasthepatient.SoatAugustaHealth,treatmentofcancerisnotmerelyonestandardprotocol,butacomplex and custom course of action developed for each individual.Thiscareisprovidedbyateamoftalentedandexceptionalprofessionals,focusingnotjustoncancer,butoneachpatient’shealthandwell-being.Theyarethemany faces of the Augusta Health Cancer Program.

Drivenbypatientandcommunityneeds—andprovidingthemostadvanceddiagnostictechniques,treatmentoptionsandcomprehensivecare—thisteamincludesspecialtytrainedphysicians,counselorsandacompassionatenursingstaff.Thefacesinclude:

• Ournursenavigatorswhoworkwithallnewlydiagnosedpatientswithbreastorprimarygastro-intestinaltumors,eliminatingbarrierstocareandimprovingoutcomeswhileansweringquestionsandproviding direction to other social or psychological individual or family needs.

• OurexpandedMedicalOncologygroup,ahandselected team who is engaged in managing cancer treatment.

• OurRadiationOncologygroupworkswithafullcomplementofstate-of-the-arttechnology.They recently expanded our program to include stereotacticradiosurgeryandstereotacticbodyradiationtherapy,highly-sophisticatedbutnon-invasivetechniquesfortreatingsmalltargetsinhard-to-reachlocations.Wealsorecentlyimplementedtheuseofrespiratorygatingwithbreath-holdingtechnologyforselectedpatientswithleftsidedbreastcancers in order to further reduce the risk of cardiac toxicity.

FROM LEADERSHIP

2AUGUSTAHEALTH•CANCER PROGRAM ANNUAL REPORT AUGUSTAHEALTH•CANCER PROGRAM ANNUAL REPORT

RonTurnicky,DO

Chairman,CancerCommittee

A MESSAGE

“This care is provided by a team of talented and exceptional professionals, focusing not just on cancer, but on each patient’s health and well-being. They are the many faces of the Augusta Health Cancer Program.”

FROM LEADERSHIP

AUGUSTAHEALTH•CANCER PROGRAM ANNUAL REPORT AUGUSTAHEALTH•CANCER PROGRAM ANNUAL REPORT

3

Ronald Turnicky, MD, Pathology, Cancer Committee ChairCatherine Barry, DO, Pathology, Cancer Liaison PhysicianRobert Kyler, MD, Radiation Oncology, Cancer Conference CoordinatorWilliam Thompson, MD, SurgeryMatthew Shapiro, MD, RadiologyReshma Khetpal, MD, Medical OncologyCynthia Allen, MD, Pathology, Cancer Registry Quality CoordinatorPatrick Baroco, MD, Palliative CareKaren Clark, MT, MBA, President, Augusta Medical Group, AdministrationSheryl Search, MSN, RN, OCN, Clinical Coordinator, Outpatient Oncology Services, Oncology NursingLeigh Anderson, LCSW, Oncology Social Worker , Psychosocial Services CoordinatorAngela Bartley, CTR, Cancer Program CoordinatorPatricia Benson, RN, Clinical Coordinator, Quality Resource Management , Quality Improvement CoordinatorKrystal Moyers, M.Ed, CHES, Community Outreach Manager, Community Outreach CoordinatorCatherine Raines, Health Educator, Community Outreach CoordinatorLisa Lenker, Clinical Research Coordinator

Additional/Other Members:William Jones, MD, UrologyRader Dod, Director of Radiology ServicesDonna Markey, NP, Medical OncologyDonna Berdeaux, RN, Breast Health NavigatorMegan Howell, RN, Aerodigestive NavigatorMary Beth Landes, MS, RD, CSO, Oncology Nutrition NavigatorStephanie Mims, Director of TherapiesClay Wilson, PharmD, BCOP, Pharmacy Oncology ServicesJoe Surrat, NP, GastroenterologyLee Phillips, Director of Volunteer Services, Pastoral CareColleen White, Chief Radiation TherapistAnnika Dean, American Cancer SocietyLinda Sutton, MD, Medical Director, Duke Cancer NetworkRenee Muellenbach, Assistant VP, Duke Cancer Network

2017TUMORBOARD Patient-focusedweeklyTumorBoardmeetingsprovideaforum for discussion of complex cases. Multidisciplinary physician attendance and presentation of National ComprehensiveCancerNetworkguidelinescontributetowards the most appropriate management of the disease. Clinical trial options are also discussed as presentedbyphysiciansandtheResearchCoordinator.TheAugustaHealthTumorBoardisalsosupportedbyDukeCancerNetworkphysicianswhoattendviavideo-conference.

Casespresentedin2016 270

AnnualAnalyticCaseload 37.5%(270/719)

Casespresentedprospectively 100%(indiagnosis,stagingand/ortreatmentphaseatpresentation)

Average of physician attendance 12

Averageofnon-physicianattendance 10

2016 CANCER COMMITTEE MEMBERS

Breast 23%

Lung 14%

Prostate 10%

Bladder 9%

Colon/Rectum 8%

Lymphatic System 7%

Female Genital 4%

Blood & Bone Marrow 4%

Kidney/Renal 4%

Pancreas 2%

Oral Cavity 2%

Thyroid 2%

Melanoma 1%

Unknown Primary 1%

All other <1% 9%

2016 Analytic Cancer Case Distribution (N=720)

4AUGUSTAHEALTH•CANCER PROGRAM ANNUAL REPORT

Methods: Lungcancerchartsfor2016werereviewed,andallcasesofstageIIIAnon-smallcellcarcinomaselectedforreviewofinitialevaluation,pre-treatmentevaluation,andfirstcourseoftreatment,andthenanalyzedwithregardtocompliancewithNCCNguidelines(Version8.2017)forinitialevaluation,pre-treatmentevaluation and treatment guidelines for stage IIIAnon-smallcelllungcancer.

Results:SevencasesofstageIIIAnon-smallcellcarcinomaofthelungwereidentified.

Regardinginitialevaluation,allsevencaseshadtherecommendedimagingofthechest,abdomenandpelvis,andbaselinebloodwork.Threewerestillsmoking,andjustoneofthemhad evidence of smoking cessation advice.

Regardingpre-treatmentevaluation,threeof the seven patients had PFTs performed. OfthosewhodidnothavePFTs,nonewerecandidatesforsurgery,andhavingPFTswouldnot have changed treatment. Four underwent bronchoscopy,andthreedidnot.Thethreepatientswhodidnotundergobronchoscopyhad risk factors that contraindicated bronchoscopyorhadbulkylesionsthatwerebiopsiedpercutaneously.Fourpatientsunderwent pathologic mediastinal evaluation withmediastinoscopyorwithbronchoscopy.Two of the three who did not have mediastinal evaluation had PET scans that showed clear evidence of mediastinal involvement. The other

COC 4.6 MONITORING COMPLIANCE WITH EVIDENCE-BASED GUIDELINES 2017 STUDY: LUNG CANCER

2016ANALYTICCANCERCASEDISTRIBUTION(N=720)

AUGUSTAHEALTH•CANCER PROGRAM ANNUAL REPORT

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onehadaT4lesionandwastreatedforpalliation,andhismanagementwouldnothavebeenchangedwithmediastinalevaluation.SixpatientsunderwentanMRIofthebrain.SixpatientshadaPETscan.

Regardingtreatment,fourpatientsweretreatedwithconcurrentradiationtherapy and chemotherapy. Two cases were treated with radiation therapy alone due to poor performance status. One patient with a superior sulcus tumorwastreatedwithneoadjuvantradiationtherapyandchemotherapyfollowedbysurgery.

NCCN guidelines recommend concurrent chemotherapy and radiation therapyformedicallyfitpatients,andradiationaloneotherwise,withradiationtherapyandchemotherapyfollowedbysurgeryreservedforpatientswithlocalinvasionotherwiseamenabletoresection. Conclusions:PatientsdiagnosedwithstageIIIAnon-smallcelllungcanceratAugustaHealthin2016underwentinitialevaluation,pre-treatmentevaluation,

PRIMARYSITE:NSCLCStageIIIA

Diagnostic Evaluation per NCCN Guidelines Treatment Evaluation Treatment Concordant CT CBC, Chemistry Smoking Mediastinal MRI FDG 1stCourse withNCCNCase Chest/ABD Platelets Profile PFTs Cessation Bronchoscopy LNEval Brain PET/CT Treatment Guidelines1 Yes Yes Yes No No No No Yes No Rad Yes2 Yes Yes Yes Yes N/A No No No Yes Rad Yes3 Yes Yes Yes No Yes Yes Yes Yes Yes Rad/Chemo Yes4 Yes Yes Yes Yes N/A Yes Yes Yes Yes Rad/Chemo Yes5 Yes Yes Yes No N/A Yes Yes Yes Yes Rad/Chemo Yes6 Yes Yes Yes No No No No Yes Yes Rad/Chemo Yes7 Yes Yes Yes Yes N/A Yes Yes Yes Yes Rad/Chemo/Surg Yes

Reference: NCCN Guidelines v8.2017 Non-Small Cell Lung Cancer; NSCL-1,-2,-4, and -7.

DatePresentedtoCancerCommittee:11/2/2017

PREPARED BY ROBERT KYLER, MD ON BEHALF OF THE AUGUSTA HEALTH CANCER COMMITTEE10 OCTOBER 2017

COC 4.6 MONITORING COMPLIANCE WITH EVIDENCE-BASED GUIDELINES 2017 STUDY: LUNG CANCER

and treatment that were substantiallyinaccordancewith the NCCN guidelines. None of the deviations from the recommended initialevaluationorpre-treatment evaluation had any meaningful impact on treatment decisions. The two patients who did not have eitheraPETscanorabrainMRIwerefrail,andnotcandidatesforcurativetreatment,andthefindingsonthese scans would not likely have changed the recommended treatment.

Overall,thisstudydemonstratesthatpatientsdiagnosedwithstageIIIAnon-small cell carcinoma of the lung diagnosed and treated at August Health are evaluated,staged,andtreatedwithahighdegreeofcompliancewiththeNCCN guidelines.

6AUGUSTAHEALTH•CANCER PROGRAM ANNUAL REPORT

MargaretRoarkspentheradultlifeinnorthernVirginia,leadingaconsultingfirmandleadingaverybusy—andgenerallyhealthy—life.Whenitwastimetoslowdownabitand‘retire’,sheandherhusbandLancemovedtotheShenandoahValley,justsouthofStaunton.Beautifulscenery,greatneighborsandtimetoenjoylife.

Aboutsixmonthsafterhermove,hernewprimarycarephysician,Dr.CaraGoodell,helpedhermakeappointments to catch up on all the screeningsthathadbeenskippedduring her relocation process. One of those screenings was a mammogram. ThemammogramledtoaCT,thenanMRI,andthenabiopsythatledtoa diagnosis that no woman wants to hear:breastcancer.

Inadditiontosurgery,therewouldbebothchemoandradiation.“Thatwasthehardestday,”saidMargaret.

LookingbacktothatdayinJanuary,Margaret’sfirstthoughtwas:“IthankGod every day that I was here instead ofinFairfaxwhenthishappened.ThereIwouldjustbeanumber.HereIwasnot.”

Whileadmittingshewasinitiallythrownbythediagnosis—shehadalwaysbeenahealthyperson—shethenapproachedherillnessinthesamewayshehadapproachedeveryprojectthroughoutherprofessionalandpersonallife:Dotheresearchandlearnallyoucan.Asktheexpertsandfollowtheiradvice.Keepapositiveattitude,getthroughitandlookforward.Andthestrategy worked. Very well.

Shereadeverythingshecouldandkeptajournalofmeticulousnotesthatincludedeverythingfrom‘tipsandtricks’toherreactionsandexperiencesaftereachtreatment,eachappointmentandeachsession.Asthenextcycleoftreatmentsarrived,shewouldlookbackathernotesfromthepreviouscycle and incorporate what she’d learned to make it easier.

Resourceswereimportant,butshequicklyadded,“Yoursupportsystemis everything. I was fortunate to have twosupportsystems:myfamilyandneighborsandmyfamilyatAugustaHealth.”

“MydaughterfromPhiladelphiacameforeverychemosession,”shesaidwhiledescribingthefirstsupportgroup.“Shewasveryinvolved.Hereevery three weeks. She went to my treatments with me and my doctor’s appointments. She cooked when I couldn’t. My sister drove here all the way from Tennessee for even more emotionalsupport.Myneighborshavebeenspectacular,too.”

Talkingaboutherdiagnosisandtreatmentswashelpful,shebelieves,becauseitledtomuchsupport.Whenyoudon’ttalkaboutwhatyou’regoingthrough,likeafriendofherswhoalsohadcancer,peopledon’tknowto help.

“ThefolksatAugustaHealthweremysecondsupportsystem,”Margaretadded.“TheyweremyexpertswhoprovidedmewithasmuchinformationasIaskedfor.Theyweremysourceforthe‘tipsandtricks’inmyjournal.Wewentthroughthistogether.Iwasn’tjustapatientoracase.Iknewthemandtheyknewme.”

MARGARET’S STORY

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BecauseMargaret’streatmentincludedbothoncology(chemo)andradiation,sheworkedwithalmosteveryareaoftheCancerCenter:

“Thegirlsinoncologywereamazing.Theywereneverrushed.Iwasalwaysthemostimportantpersonintheirday,andtheywerealwayshappy.”

“MaryBeththedietitiangavemealotofinformationaboutwhatIshouldeatandwhatIshouldn’teatduringchemo,andItooknotesinmyjournaltorecordeverythingthatmademenauseous.Ilearnedveryquicklynottoeatrawonions,andherrecommendationtohavetomatojuicebeforeeverymealworkedlikeacharm.Touseplasticutensils,notthemetalones.Toeatsixsmallmealsinsteadofthreebiggerones.Nottoeatbluecheeseormediumraresteakbecauseofthebacteria.Ilovebluecheesedressingandsteak.ThatwasthefirstmealIhadwhenIwasfinished.”

“MariaandJesseinradiationwereexcellentandalwaysthereforme.TheycouldjustsensewhenIneededahug.Theywouldmarkupspotswithabluepencil.Itoldthemwhenradiationwasdone,Iwasgoingtobuythemadultcoloringbooksbutremovethebluepencilsfromthebox.”

“EvenDave,theguywhoparkedmycareveryday,Iknewhimanditmadeiteasier.”

“AndDonnaBerdeaux,mybreastnavigator,wasmyrock.IhadneverevenheardofabreastnavigatorandnowIhadone. She was fantastic and met every need. She was at every doctor’s appointment with me. She would call me and check uponme.Itdidn’thurtthatshe’dbeenthroughthesameexperience(Donnaisalsoabreastcancersurvivor)becauseIknewshereallyunderstood.”

Margaret’sfirsttreatment,achemotreatment,“wasactuallyprettyhorrible,butitdidgetbetter.Itooknotesandlearnedfromeachone.Beforethenewcyclewouldbegin,I’deatmoreproteinandpushmyselftoexercisemoretobuildupenergyandstaminatogetthroughit.IknewthefirstandseconddayswouldbeOK,butdayssevenandeightwouldbeworse.WhenIknewwhattoexpect,itwaseasier.”

Margarethasfinishedhertreatmentsandtransitionedintoanti-estrogentherapy.Butshehasn’tleftAugustaHealthCancerCenter.She’sbackasavolunteer.

“Iwanttogivebacktothosegirlswhohelpedmesomuch,”saidMargaret.“Icantakelunchordersandgetdrinks.Icanclean.Icansitandtalkwithpatients. I can do whatever they need me to do so it’s easier for the care giverstoconcentrateongivingthecare.”

Andthatmeticulouslykeptjournalthatshekept?She’sgivenittoanotherwomanwithcancertohelphergetthroughherjourney.

“I want to give back to those girls who

helped me so much,” said Margaret.

The Faces of Cancer ProgrammingAccreditation and regulatory compliance dataismanagedandcoordinatedbyprofessional tumor registrars and program coordinators.

THE FACES OF THE AUGUSTA HEALTH CANCER CENTER

The Faces of Nurse NavigatorsNursenavigatorsfunctionasguidesthroughthejourneyofcancercarebyprovidinginformationandsupportevery step of the way from diagnosis through recovery.

The Faces of Radiation TherapistsRadiation therapists perform daily radiation treatments according to the treatment plan developedbyaphysician and dosimetristtobesure the radiation impacts the cancer as preciselyaspossible.

The Faces of PharmacistsPharmacists working in the cancer center prepare medications totreatcancer,aswell as providing expertise on medications used to treat symptoms and sideeffects.

The Faces of Oncology NursingOncology nurses provide chemo treatments according to the treatment plan developed bythemedicaloncologist—andprovide informa-tion and support during long chemo sessions.

The Faces of SupportPatientsandstaffaresupportedbyanexperienced office manager and front deskstaff,eachexpertintheirfield.

The Faces of SurgeonsSurgeons from throughout Augusta Health’s medical staffprovidesurgicalexpertise in specialty areassuchasbreastcancer and colorectal cancer.

The Faces of ResearchThrough its affiliation with DukeHealth through the Duke Cancer Network,AugustaHealth’s Cancer Center participates in clinical trials that evaluateprevention,newdrugs,treatments,side-effectmanagementand survivorship.

The Faces of OncologistsLocal Radiation Oncologists and Medical Oncologists/Hematologists,practicingonlyatAugustaHealth,providespecialtycancercare,evaluatinganddevelopingacustomtreatment plan for each patient.

The Faces of ServiceServicebeginsoutsidethedooratAugustaHealth,where valet parkers take care of the car to allow patients to focus on getting better.

The Faces of Nutrition CounselingA registered oncology dietitian supports patients’ eating challenges and nutritional needsbefore,during and after treatment.

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• OnSeptember20,2017,theAugustaHealthCancerCenter,aspartofitsassociationwiththeDukeCancerNetwork,presentedENDURE: Engagement with Novel therapies and Decision making through breast cancer Education.IvyAltomare,MD,Associate Professor of Medicine at Duke University School of Medicine,spoketomedicaloncologists,nurses,pharmacistsand other health professionals on investigations and clinical applicationsofCDK4/6inhibitorsinbreastcancer.

• OnOctober19,2017,acancersymposium,Managing the Health of Cancer Patients on the Frontlines,waspresentedtolocalprimarycarephysicians,nurses,pharmacists,advancedpracticeproviders and other local health professionals. The focus was on lungcancerandbreastcancer.ProgramDirectorwasRobertKyler,MD,medicaldirectorofRadiationOncologyatAugustaHealth.KelvinRaybon,MD,FACP,medicaldirectorofMedicalOncology/HematologyatAugustaHealthmoderatedthelungcancerissues,andWilliamThompson,MD,FACS,surgeonwithShenandoahValleySurgicalAssociates,moderatedthebreastcancerissues.Faculty included Augusta Health physicians and speakers from the Duke University Health System.

ADVANCED CLINICAL

EDUCATION WITH

MatthewShapiro,MD

AdvancedclinicaleducationbyfacultyatDukeUniversitySchool

ofMedicine,broughtonsitetotheAugustaHealthcampus,is

abenefitoftheCancerProgram’saffiliationwithDukeHealth.

Examplesfromthepastyearinclude:

LindaSutton,MD,Associate Chief Medical

Officer for Duke NetworkServices,

Medical Director for the Duke Cancer NetworkAssociate Professor of

Medicine,DukeSchool of Medicine

Inbaseball,thetripleplayistherarefeatthatendsaninninginoneplay,usuallywithouttheballleavingtheinfield.Oneofthemoststoriedinfieldsinhistory—threemenrenownedforturningtripleplays—wastheChicagoCubsoftheearly1900s.Theconstantrecitationbyannouncersoftheirtripleplays,‘TinkertoEverstoChance’hasbecomeanexpressionthatcharacterizesanyprocessthathappenswithsmoothness,precisionandhigh-caliberteamwork.

Inthebattleagainstlungdiseaseandlungcancer,AugustaHealthhasassembleditsownhigh-caliberteamthatrivalsthetriplethreatof‘TinkertoEverstoChance’:RadiologistMatthewShapiro,MD;PulmonologistC.LauraGonzalez,MD;andThoracicSurgeonMiguelAguinaga,MD,FACS.

Not just Tinkering with CTs: Matthew Shapiro, MD leads the hunt for lung cancer through screenings with Low Dose CT

A TRIPLE THREAT AGAINST LUNG DISEASE

MatthewShapiro,MD

C.LauraGonzalez,MD

MiguelAguinaga,MD,FACS

Formanyyears,thoseatriskforlungcancerhadnoeffectivescreeningforearlydetection.Whilemammogramsweredevelopedforbreastcancerandcolonoscopiesforcoloncancer,thetechnologywasnotthereforlungcancer.

Thelackofaneffectivelungcancerscreenwasespeciallytroublingforphysiciansbecausetherearenoearlysignsorsymptomsforlungcancer.Mostlungcancerswerediagnosedinalatestage,aftersymptomsappeared.Late-stagelungcancerdoesnothaveahighsurvivalrate.Eachyear,morepeoplediefromlungcancerthanbreastcancer,coloncancerandprostatecancercombined.

Sofromthe1950sthroughthe1970s,healthprofessionalstriedtodevelopscreeningsbasedontechniquessuchaschestx-raysandsputumanalysis,buttheycouldnotdemonstrateanysurvivalbenefit.

“Forcloseto20years,theattemptstodevelopeffectivelungcancerscreeningwerenotsuccessful,”saysMatthewShapiro,MD,aradiologistatAugustaHealth.“Thetechnologyavailable,suchasanx-ray,wasa2Dimageofa3Dstructure—thelung—soitcouldnotdetectspotsorlesionsearlyenoughtochangetheoutcome.”

That changed in 2011 with the results of the National Lung Screening Trial usingLDCT:LowDoseCTScreeningforLungCancer.Thisstudyshoweda20%decreaseinlungcancermortalityinpatientswhohadyearlyLDCTscreening.

SinceLDCTisascreeningCT,itusesalowerdose—only20%--ofthedoseof radiation used for a diagnostic CT. It takes an image that is a very thin ‘section’ofthelung.Becausethesectionissothin,itcanreveallesionsandspotsthatwerenotvisibleinachestx-ray.

“WithLDCT,weareabletofindanddiagnoselungcancerwhenit’sverysmallandinitsearlieststages,whenit’smoretreatableand,inmanycases,curable,”addsDr.Shapiro.

LDCTiscoveredbyMedicareandmostotherinsurancesforpatientsconsideredathigh-riskforlungcancer.Tobeconsideredhigh-risk,thefollowingcriteriamustbemet:

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AUGUSTAHEALTH•CANCER PROGRAM ANNUAL REPORT

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• Patientmustbebetween55and77yearsofage; • Patientmustbeasymptomatic(havenoexisting signsorsymptomsoflungcancer); • Patientmusthaveatobaccosmokinghistoryofat least30“packyears”. Apackyearisdefinedassmoking1packadayfor1year.Smoking2 packsadayqualifiesastwopackyearsinaoneyearperiod. • Patientmustbeacurrentsmokeroronewhohasquitwithinthelast15 years;and • PatientmusthaveawrittenreferralfortheLDCT.

“IthinkanLDCTistheleastinvasive,‘easiest’screeningforourpatients,”addsDr.Shapiro.Thereisnopreparationtodrink,andyoucaneatbeforethe

screen.Therearenoneedlesorpaddles,andyoudon’t even have to change as long as the clothing on your chest doesn’t contain metal. You do have toremovejewelry,andholdyourbreathfor10to15secondswhilelyingonthetable.It’sactuallyveryquickandeasy.”

Justlikemammogramsandcolonoscopies,evenifnothingisfound,therewillbefollow-upscreenings(yearlyorsooner)tobesurenothingdevelopsovertime.Ortobeabletotakequick

action if something does develop.

AugustaHealthbeganperformingLDCTin2014with34screenings.Sincethen,almost1100initialandfollow-upscreeningshavebeencompleted,and18cancershavebeenfound.

“Nationalstudiestellusthatforevery100peopleyouscreen,you’llfindonecancer,”notesDr.Shapiro.“Ourratehasbeenhigherthanthat.With1100screens,we’vefound18lungcancers,notthe11expected.The18cancerswe’vepickedupthroughscreeninghavegenerallybeenfoundinearlystages,andbeforethepatienthadsymptoms.”

Whileit’simportanttonotethatnotalllungcancerswillbefoundwithLDCT,and some of the cancers found using LDCT may have already spread to other organs,Dr.Shapiroandhiscolleaguesarebeginningtoseeashifttowardslungcancerbeingdiagnosedinearlierstages.

AccordingtoDr.Shapiro’sstatistics,beforeAugustaHealthbeganLDCT,72%of the lung cancers diagnosed at Augusta Health were Stage 3 or Stage 4 cancers,andonly15%wereStage1.Inthelasttwoyears,justunder60%ofthelungcancersdiagnosedatAugustaHealthhavebeenStage3orStage4,andalmost28%havebeenStage1.Itisevidenceofthatpredictedshifttodiagnosing lung cancer in its earliest stage. Since many patients still do not seekcareuntiltheyhavesymptoms,Dr.ShapiroandothersbelieveasmorepeoplebecomeawareoftheavailabilityofLDCTscreeningandgetscreened,theshifttoearlystagediagnoseswillbecomeevenmoreevident.

“We’regatheringstatistics,”addsDr.Shapiro,“sothat,afterwehavefiveyearsofdata,wecanshowtheimpactofscreeningovertime.ButIthinkIalreadyknowwhatthestatisticswilltellus.Thisscreeningissavinglives.”

WhenDr.Shapirodetectsaspot,orlesion,throughLDCTscreening,herefersthepatientalongfordiagnosis—oftenthroughanavigationalbronchoscopybyDr.LauraGonzalez.

Tinker to Evers. Shapiro to Gonzalez.

Ever searching for answers, Laura Gonzalez, MD uses navigational bronchoscopy to diagnose lung cancers at their earliest stages

“We’rechangingthegameplanforlungcancer,”saysLauraGonzalez,MD,apulmonologist at Augusta Health.

Oncelungdiseaseissuspected,oranabnormalityisfoundthroughLDCT,Dr.GonzalezcanvisitwiththepatientonaWednesdayafternoon—herdedicatedLungClinichours—andifneeded,scheduleabiopsyinaweekorless.

“It’sfrighteningtobetoldthereissomething‘abnormal’withyourlung,”sheexplains,“andtoreducethatanxiety,peopleneedtobeseenassoonaspossible.”

WhilesomepatientsareadvisedthatthebestcourseistorepeattheirLDCTinafewmonths,othersarescheduledforanavigationalbronchoscopy,anadvancedtechniquethatDr.GonzalezperformsatAugustaHealth.

Whatisnavigationalbronchoscopy?

“I like to say that it’s using GPS in the lung,” explains Dr. Gonzalez. “It’s locater strategy electro-navigation. In the past, most patients didn’t come in until they had advanced symptoms. We often had to do an ‘open’ surgery with a large incision. Even needle biopsies in the lung had a 30-50% risk of lung collapse.”

With navigational bronchoscopy, though, Dr. Gonzalez takes the image from the CT and lines it up over a live image from a bronchoscope, and the result is a computer generated image of the bronchial tubes in the lung. It looks like a 3D drawing. She can trace along the image with a bronchoscope, then reach into even smaller areas with a catheter that can guide her to the lesion identified in the image. If she needs to go even smaller, a tiny, blue laser microscope can slide into the catheter. There, she can pull out a sample to send to pathology. She can remove a small malignancy. She can also leave a ‘marker’ behind—so that if additional surgery or radiation therapy is needed, the exact spot can be located precisely and easily.

While she does diagnose patients referred after an LDCT, she also sees many other patients diagnosed with lung disease. She is passionate about making excellent care available to patients in the area.

“We are working to make quality pulmonary care more accessible to those in this community,” she says. “When you’re sick, 30 miles up the road is a long haul. We want them to have the same quality care, and to make that great care available here near their homes. LDCT and navigational bronchoscopy are game changers. Before, when you didn’t know to seek help until you had symptoms of lung cancer, it was usually too late. Now we can get to people sooner and offer a cure.”

When Dr. Gonzalez identifies something that needs surgery, she refers the patient to a thoracic surgeon like Dr. Miguel Aguinaga.

Evers to Chance. Gonzalez to Aguinaga.

Leaving nothing to Chance, Miguel Aguinaga, MD, FACS begins a robotic surgery program for thoracic surgery patients at Augusta Health

There’s been much change over the years in thoracic surgery—surgery that concentrates on organs in the chest such as lungs, diaphragm, esophagus

and chest wall. And those changes have been good for patients.

“Before we began using minimally invasive techniques, thoracic surgery would be quite traumatic, painful and difficult for patients,” explains Miguel Aguinaga, MD, FACS, who came to Augusta Health in August after 14 years in Arkansas. “Incisions could be as long as 30 inches, and we needed to spread, or perhaps remove ribs. It could be a long stay in the hospital and an even longer recovery.”

“Now, however, we are moving towards minimally invasive techniques that use small incisions,” he says. “About 95% of our surgeries are minimally invasive, providing many benefits to the patients. There are fewer medications, and there is less bleeding and fewer complications. Recovery time is shorter, and patients can get back to their lives quicker.”

Minimally invasive techniques like VATS (Video Assisted Thoracic Surgery) use tiny incisions—about ½ inch long—and a small camera that is introduced into the chest to guide the surgeon. Dr. Aguinaga believes that minimally invasive surgery is more challenging for surgeons, which may be why only 20 to 30% of thoracic surgeons are using it, but he believes it is a better option for most patients.

Like VATS, robotic surgery is also minimally-invasive, and Dr. Aguinaga has scheduled the first robotic lung surgery at Augusta Health for December.

“Because a surgical robot does great work in small and crowded places, some locations in the chest are perfect applications for the surgical robot. It can be and excellent tool for a thoracic surgeon,” he adds. Dr. Aguinaga is the thoracic surgeon who performed the first robotic lobectomy in the state of Arkansas, and he sees great opportunity for using it in his practice here.

“I left a busy practice in Arkansas after 14 years because I was very optimistic about what can be accomplished here,” he notes. “There is much in place to provide quality care for lung disease. The surgical robot here is a newer robot than what I had in Arkansas. Navigational bronchoscopy is well developed here with Dr. Gonzalez. I was trying to start (LDCT) Lung Cancer Screening there, and it’s already been in place several years here. I think we will make a difference for people.”

Tinker to Evers to Chance. Smoothness, precision and high-quality teamwork. Shapiro to Gonzalez to Aguinaga.

540-322-5960 www.augustahealth.com