A PUBLICATION FOR COMMUNITY PHYSICIANS
‘Sunshine vitamin’ lights up new research Vitamin D may have important dual role
FALL 2014 if necessary, to reach a Vitamin D level of at least 35 and perhaps ideally, 50,” Dr. Rao said. “These levels may also prevent a recurrence of breast cancer in those patients who have been previously diagnosed.”
OTHER INDICATIONS FOR VITAMIN D
BY DEBRA GELBART
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itamin D may play multiple roles in the management of breast cancer, says a medical oncologist with Banner MD Anderson Cancer Center in Gilbert who specializes in treating breast and lung cancer. “There are some studies that suggest that low Vitamin D levels may be associated with the development of breast cancer,” said Santosh Rao, M.D., who also specializes in breast cancer prevention and in the practice of integrative oncology. “One study showed that Vitamin D levels of at least 50 are associated with a significant decrease in breast cancer. Epidemiologic studies suggest a role for Vitamin D as well.” He cautioned that overall, studies don’t indicate an undisputed correlation between Vitamin D and breast cancer.
REDUCING THE RISK In places known for a high incidence of skin cancer — including Arizona — both the National Comprehensive Cancer Network and the American Society of Clinical Oncologists recommend that residents wear sunscreen regularly. Vitamin D is primarily made from skin exposure to ultraviolet light from the sun. While Dr. Rao agrees with recommendations for sunscreen protection to prevent skin cancer, the use of sunscreen may explain how people living in Arizona can still have low vitamin D levels. “So what we’re recommending to potentially reduce the risk of breast cancer is supplementation,
Vitamin D3 is the best-absorbed form of Vitamin D, although it comes from animal sources. For those who prefer a vegetarian source, Vitamin D2 is also acceptable, he said. Some studies suggest that a Vitamin D level of 40 is helpful in preventing the bone loss commonly seen with aromatase inhibitor therapy (such as Arimidex and Femara) for breast cancer patients, Dr. Rao said. Aromatase inhibitors put patients at risk for osteoporosis, he explained. Dr. Rao usually recommends 800 I.U.s of D3 for his patients taking aromatase inhibitors, although that varies depending on a patient’s current Vitamin D level. It is unknown whether higher vitamin D levels carry the same benefit for all people. Studies have shown that lower levels of Vitamin D don’t necessarily correlate with a higher risk of fracture in African-American women, he said. In the majority of cases, he added, calcium will be prescribed for these patients along with the Vitamin D. But some studies have suggested a potential link between calcium supplementation and increased risk
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Smoking cessation program
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Early breast cancer detection New Lung Cancer Clinic 4 Lung cancer conference 5 Research trials
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Ovarian cancer risk in Hispanic women
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Banner MD Anderson physicians
In vitro studies have
for heart disease in postmenopausal women, so it may be incorrect to suggest that the combination of calcium and Vitamin D carries no risk for patients, he said. “We tend to give Vitamin D and calcium together, so the question becomes: are we potentially increasing heart disease down the line? We simply don’t have a great understanding of this yet.”
shown that Vitamin D helps cancer cells die more quickly. While its effect on human cancer is still unclear, the evidence is suggestive.
BOTTOM LINE “In vitro studies have shown that Vitamin D helps cancer cells die more quickly. While its effect on human cancer is still unclear, the evidence is suggestive,” Dr. Rao said. “Vitamin D likely has an anti-inflammatory effect, and may stimulate the immune system, which are both important for the prevention of cancer.” Guidelines vary in terms of calcium and Vitamin D supplementation to prevent bone loss and fractures. The
— Santosh Rao, M.D. U.S. Preventive Services Task Force stated last year that there was insufficient evidence to recommend calcium or Vitamin D supplementation other than in women over 65 years of age, Dr. Rao said. However, he said, it is more common for health care practitioners to recommend supplementation for those patients at higher risk for bone loss, for example
due to hormonal therapy for breast or prostate cancer. Furthermore, a patient’s current bone health and other clinical risk factors should also guide physicians in prescribing calcium and Vitamin D together, he said. “Not everyone needs to be on calcium and Vitamin D supplementation as they age,” Dr. Rao said. “It’s more nuanced than that.”
Banner MD Anderson’s Undiagnosed Breast Clinic: Helping patients get speedy answers When a patient experiences breast pain, discovers a breast lump or is told her mammogram is questionable, the Undiagnosed Breast Clinic at Banner MD Anderson Cancer Center in Gilbert can help ease her worries and help her referring physician. The Clinic, which is open to men, too, provides clinical exams, diagnostic imaging, procedures, treatment if necessary and follow-up—all under one roof and with lab and pathology results available to the patient within 48 hours.
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How does the Undiagnosed Breast Clinic support physicians? Our clinic serves as a great entry point for patients into our health system. Many of our patients are self- referred; others
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are sent to us from community physicians. Once they are seen in our clinic, they are referred to other specialists in our system, if appropriate. We are also always here as a resource for physicians who may have patients with undiagnosed breast concerns.
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How does a physician refer a patient to the Clinic and under what circumstances would that referral occur? If a physician has patients with concerns regarding abnormal breast imaging, findings on exam or breast symptoms, we would be happy to see them in our Clinic. The referring physician should request an Internal Medicine Consult and specify “Undiagnosed Breast Clinic” in comments/ reason for visit.
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Does a referring physician continue with the patient’s care during her (or his) diagnosis and treatment? The referring physician should continue to be involved with the patient’s care by addressing any concerns that the doctor was primarily seeing the patient for, especially if the patient is still having issues that fall under the physician’s scope of practice.
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What kind of communication does the Clinic maintain with a referring physician? A copy of our note is faxed to the referring physician and we are also always available for conversation regarding the patient’s plan of care.
Dr. Daniel Chamberlain and Dr. Klaus Wagner
4 disciplines, 1 afternoon Patients at Banner MD Anderson’s new Lung Cancer Clinic consult with all their doctors in a single afternoon BY ELISE RILEY
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he new Lung Cancer Clinic at Banner MD Anderson Cancer Center in Gilbert simplifies the process of arranging a cancer care team. At the Lung Cancer Clinic, it’s a one-stop shop. “A lot of times, what patients experience is a fragmented approach,” said Klaus Wagner, M.D., PhD a medical oncologist at Banner MD Anderson. “You see a surgeon and they partner with an oncologist who’s a separate entity, and then there’s a pulmonologist. It’s very fragmented.” But at the Lung Cancer Clinic, patients will see doctors from all four care disciplines — a pulmonologist, a thoracic surgeon, a medical oncologist and a radiation oncologist — in a single day. Patients don’t have to coordinate with four different offices or drive across town to see four different caregivers. Instead, they can meet with a single team that’s devoted to their care. “Traditionally, by the time you’ve
seen all these doctors it might take a few weeks,” said Daniel Chamberlain, M.D., a radiation oncologist at Banner MD Anderson. “What we’ve done is allow patients to see all the needed specialties in the same afternoon.”
TEAM APPROACH Once a patient sees their team of doctors — the number of which can vary, depending on the stage of cancer — the doctors meet to go over the case as a team. Tests are reviewed, course of treatment is considered, and the work begins. “You have better collaboration as the patient is going through treatment,” Chamberlain said. “Everyone collaborates and comes up with a plan where we’re all on the same page.” Beyond pulmonology, surgery and oncology, patients also have access to behavioral health care and integrative medicine. From smoking cessation to nutrition, exercise and emotional support, the Lung Cancer Clinic provides a complete spectrum of care.
I’m not aware of anywhere else in the Valley where you can see all the necessary providers in one afternoon. — Daniel Chamberlin, M.D. “As a primary care physician, this is advantageous because you only have one office to communicate with,” Chamberlain said.
TRUE SPECIALISTS The doctors at the Lung Cancer Clinic have a laser focus on treating lung cancer. “These are cancer specialists who’ve chosen to sub-specialize in lung cancer,” Chamberlain said. “I’m not aware of anywhere else in the Valley where you can see all the necessary providers in one afternoon.” BannerMDAnderson.com
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More and more patients are choosing Banner MD Anderson for their lung cancer treatment – the hospital treated 363 lung cancer patients in 2013; halfway through 2014 Chamberlain and his team had already treated 255, and the specialized clinic only opened in June. The Lung Cancer Clinic was modeled after multi-disciplinary centers at academic institutions. Most patients at the Lung Cancer Clinic are either early-stage or intermediate, but Dr. Wagner is conducting clinical trials specifically for stage 4 lung cancer treatment.
It’s important to stage the patient properly. You might withhold the more appropriate treatment, or you might put them through an unnecessary surgery. — Klaus Wagner, M.D.
Lung Cancer Conference to Focus on Raising the Standard of Care Physicians from a variety of disciplines who care for patients with lung cancer are invited to a day of learning at the First Southwest Lung Cancer Symposium sponsored by Banner MD Anderson Cancer Center in Gilbert in March 2015. The daylong conference will focus on innovations and advances in care for all stages of lung cancer. “Particularly when you’re treating stages 1, 2 and 3, you need a good partnership with all of the specialties,” said Klaus Wagner, M.D., PhD, a medical oncologist at Banner MD Anderson. “We’ll go over what we feel is the most appropriate lung cancer care by pulmonologists, thoracic surgeons, medical oncologists and radiation oncologists.” Speakers from Banner MD Anderson, The University of Texas MD Anderson Cancer Center and other renown cancer centers will cover the current standard
We’re All In
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here’s power in community! Our family, our friends, our neighbors, our co-workers. And there’s nothing more powerful than knowing we have community behind us, especially during our darkest hours. At Banner MD Anderson Cancer Center in Gilbert, WE ARE ALL IN for the fight against cancer, and we believe in the healing power of a supportive community. That’s where you come in. You can be part of this supportive community! Join us as we collect messages of hope to encourage people fighting a battle with cancer. You can upload a video or write a message at WEAREALLIN.com.
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of care for treating lung cancer, with sessions that cover topics ranging from proper staging of a patient to advances in molecular testing and therapy. “We have much better tools than we did even five years ago,” Wagner said. “It’s important to stage the patient properly. You might withhold the more appropriate treatment, or you might put them through an unnecessary surgery.” Wagner also explained that advances in molecular testing are helping care providers better determine the type and course of treatment. “Not all patients are getting tested for these as quickly as they should be,” he said, “and we want to make an effort to educate. We want to raise the overall standard of care for lung cancer.” To be added to the mailing list for the lung cancer conference, please email bmdaccpublicrelations@bannerhealth.com.
These messages will be shared with patients at Banner MD Anderson, as well as our satellite radiation oncology programs in Mesa and Thunderbird. “It’s a fact that patients who have strong social networks and support do better getting through their therapy than those who don’t,” said Santosh Rao, M.D., a medical oncologist and integrative medicine specialist at Banner MD Anderson. “That’s why we want to encourage loved ones and the community to participate in the most positive way possible in a cancer patient’s experience.” We hope you’ll take part in sharing your inspirational message. Because when it’s a battle with cancer, we want everyone to know WE’RE ALL IN.
New research trials offer cancer patients
new treatment opportunities, hope Multi-year investigations conducted as part of larger national studies BY KRISTINE BURNETT
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esearch is a fundamental part of how Banner MD Anderson Cancer Center in Gilbert is making a difference in people’s lives through excellent patient care while simultaneously Making Cancer History®. Virtually all of our physicians take part in clinical trials and other studies designed to validate hypotheses, test theories and, ultimately, lead to new treatment protocols. Among the 23 clinical trials currently underway at Banner MD Anderson are two new studies centered on treating metastatic breast cancer. According to Mary Cianfrocca, DO, division chief of internal medicine and director of the breast cancer and clinical cancer genetics programs at Banner MD Anderson, both trials are multi-year investigations being conducted as part of larger national studies.
BRCA-POSITIVE PATIENTS Targeted therapy continues to play an increasingly prominent role in cancer treatment. However, there are currently no targeted therapies approved specifically for breast cancer patients with either the BRCA1 or BRCA2 gene mutation. Through a clinical research trial sponsored by AbbVie, Banner MD Anderson will evaluate the efficacy of a new treatment for BRCA-positive patients who have metastatic breast cancer. Making it even more unique, the AbbVie trial is open to both men and women who meet all study
requirements. Participants in this placebo-controlled study will receive chemotherapy in combination with the targeted investigational drug Veliparib or a placebo. Treatment duration varies based on the individual chemotherapy needs of each patient. Banner MD Anderson opened the trial in March as the only research site in Arizona with plans to enroll three study participants. “BRCA-positive metastatic breast cancer is rather rare,” said Cianfrocca. “Given that this is a limited patient population to begin with, our study enrollment will be somewhat small in scope.”
HER2-POSITIVE PATIENTS Human epidermal growth factor receptor 2 (HER2) is a protein that promotes the growth of cancer cells. Approximately 20–30 percent of breast cancer patients test positive for HER2. Banner MD Anderson in February launched a Pfizer trial for
HER2-positive patients who have been diagnosed with metastatic breast cancer. Through the trial, participants will receive chemotherapy with paclitaxel in combination with Herceptin or a biosimilar drug designed to target the protein. Banner MD Anderson plans to enroll a total of 15 study participants. Since the trial will specifically test a first-line therapy, it is only open to patients who have not received prior chemotherapy to treat their metastatic breast disease. Prior hormonal therapy does not impact eligibility. Physicians interested in learning more about clinical trial opportunities for their patients, including eligibility requirements for the AbbVie and Pfizer trials, are encouraged to speak with the Banner MD Anderson research coordinator by calling (480) 256-3420.
To view a complete list of open trials, visit www.BannerMDAnderson.com/ ClinicalTrials. BannerMDAnderson.com
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Banner MD Anderson launches
smoking cessation program Counseling-based program to identify those with high-risk for lung cancer BY DEBRA GELBART
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atients who smoke or recently quit and are receiving care at Banner MD Anderson Cancer Center in Gilbert can enroll in the cancer center’s new tobacco cessation initiative, which is designed to work in concert with the state’s “ASH Line” quit-smoking program. The Banner MD Anderson Tobacco Cessation Program, which for most patients will run for six to eight weeks, offers weekly counseling sessions, prescription medications if necessary to help a patient quit smoking, and follow-up visits with a nurse practitioner either in person or over the phone.
HIGH RISK FOR CANCER Banner MD Anderson soon will begin a lung cancer detection program for patients considered high risk to contract the disease. “Patients who are part of our tobacco cessation program who are considered at high risk for developing lung cancer can be easily routed into our surveillance screening program,” said Santosh Rao, M.D., a medical oncologist at Banner MD Anderson who specializes in lung and breast cancers. Patients in the Banner MD Anderson system who want to participate in the cancer center’s tobacco cessation program can ask
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their Banner MD Anderson physician to refer them, Dr. Rao said. Private practice physicians whose patients are already part of the Banner MD Anderson system are encouraged to let those patients know about the new program. As the program gets more established, Dr. Rao added, Banner MD Anderson personnel will reach out to hospitalists and physicians in private practice and in primary care clinics so they can refer their patients to Banner MD Anderson’s Tobacco Cessation Program.
ASH LINE Concurrent participation in the Arizona Smokers’ Helpline (ASH Line) program is important, Dr. Rao explained, so that patients get the basic help they need to quit smoking.
“Our program is intended as a supplement to ASH Line,” he said. ASH Line is located in the Mel and Enid Zuckerman College of Public Health at the University of Arizona in Tucson and is funded by the state tax on tobacco products. The ASH Line offers free telephone and Web-based services, in both English and Spanish, to help people leave tobacco behind. “Quit coaches” are former smokers located in Arizona who help current smokers leave tobacco behind through phone-based coaching. In addition, smokers can download an app called WebQuit that encourages them to work through activities, set goals and monitor their progress online.
Smokers can access the ASH Line by calling 1-800-556-6222 or by visiting ashline.org.
REVIEWING THE RESULTS
Study shows education is key in
reducing ovarian cancer in Hispanic women Goal is to expand the knowledge base, grow community program BY MEGHANN FINN SEPULVEDA
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ast winter, Matthew Schlumbrecht, M.D., gynecologist oncologist at Banner MD Anderson Cancer Center in Gilbert, launched an investigatorinitiated study to determine the level of knowledge surrounding ovarian cancer related to risk factors, prevention, symptoms and treatment in Hispanic women. In partnership with Mesa Public Schools Family Literacy Program, the objective of the study was to develop an educational tool based on a knowledge assessment and to implement a community program for Hispanic women in Arizona.
IDENTIFYING DEMOGRAPHICS The National Cancer Institute reports that 60 percent of Hispanic women cannot define cancer and 57 percent have never heard of
genetic counseling. The City of Mesa was identified as a unique community, with 25 percent of the population Hispanic, and 38 percent of those residents foreign born. A brief questionnaire was developed in English and Spanish consisting of multiple choice and true and false formats. “We were looking to assess knowledge areas that included the basic female anatomy, genetic risk factors, preventative strategies, treatment and symptoms of ovarian cancer,” said Schlumbrecht. “In order to participate, women were required to be 18 years of age, able to read in English or Spanish and provide consent.” Of the 166 participants, 95 percent said they were not originally from the U.S. and 91 percent said that Spanish was their preferred language. Ninety percent of the participants also reported an annual household income of $25,000 or less.
The questionnaire aimed to measure the basic and symptom knowledge of ovarian cancer. Of all the categories, questions about risk factors scored the lowest. “There is a new founded BRCA mutation gene in Latin American women,” Schlumbrecht said. “These women are also not aware of the hereditary risks and how ovarian, fallopian and breast cancer can actually be prevented.” Only nine percent of women answered correctly when asked if tying fallopian tubes as a form of birth control could reduce the risk of ovarian cancer.
SYMPTOM KNOWLEDGE Ovarian cancer is known to present only in the late stages, and many women go undiagnosed for months. “Some women may not even be symptomatic,” Schlumbrecht said. “Typical symptoms include abdominal pain, loss of appetite, irritated bowels and bloating.” Usually women are diagnosed at Stage III or Stage IV and require a combination treatment of surgery or chemotherapy. “This is why it is so important to gain heightened awareness so we can diagnose early before the need for treatment,” Schlumbrecht said.
ONGOING OUTREACH Schlumbrecht and his colleagues are currently analyzing the data to determine the next steps to expand the program. “We are hopeful that these women will share their knowledge with other family members such as their mothers, grandmothers and aunts,” Schlumbrecht said. “These women need to be aware of what should prompt them to see their doctor. They deserve the same amount of education as other populations.” BannerMDAnderson.com
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INTRODUCING
Banner MD Anderson PHYSICIANS
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anner MD Anderson Cancer Center physicians are highly specialized in their fields of expertise. In addition to our main facility in Gilbert, Banner MD Anderson provides radiation oncology treatment at Banner Desert Medical Center in Mesa and Banner Thunderbird Medical Center in Glendale.
PATIENT REFERRALS To make a referral to a physician on our staff, please call 480-256-3433. Banner Thunderbird Radiation Oncology: (602) 865-5445 Banner Desert Radiation Oncology: (480) 412-3808
To contact a member of medical staff, call 480-256-6444 and ask for the physician to be paged.
HEMATOLOGY & MEDICAL ONCOLOGY SECTION Tomislav Dragovich, MD, PhD, Division Chief Gorgun Akpek, MD, MHS Santosh Rao, MD Shakeela Bahadur, MD Farshid Dayyani, MD, PhD Jade Homsi, MD H. Uwe Klueppelberg, MD, PhD Javier Munoz, MD Rebecca Armendariz, MD Matthew Ulrickson, MD Klaus Wagner, MD PhD Bryan Wong, MD
Diljeet Singh, MD Benny Tan, MD Warren Tseng, MD
Andrew Price, MD, CAQ Interventional Radiology Jignesh Patel, MD
RADIATION ONCOLOGY SECTION
CRITICAL CARE SECTION
Matthew Callister, MD, Division Chief, Interim Medical Director Yerko Borghero, MD (Banner Desert) Dan Chamberlain, MD Emily Grade, MD Rachit Kumar, MD (Banner Thunderbird) Anna Likhacheva, MD Jeff Richmond, MD Terence Roberts, MD Shervin Shirvani, MD (Banner Thunderbird)
Shiva Birdi, MD, Division Chief Jijo John, MD Deven S. Kothari, MD Dean Prater, MD Ravindra Gudavalli, MD
ONCOLOGY SURGERY SECTION Karen Pitman, MD, Interim Division Chief Julie Billar, MD Stephanie Byrum, MD Al Chen, MD Randall Craft, MD Mark Gimbel, MD Joseph Mashni, MD Matthew Schlumbrecht, MD, MPH Thomas Shellenberger, MD
DIAGNOSTIC IMAGING SECTION Donald Schomer, MD, Division Chief, CAQ Neuroradiology John Chang, MD, PhD Philippe Lanauze, MD Vilert Loving, MD Harvinder Maan, MD, CAQ Neuroradiology Rizvan Mirza, MD Susan Passalaqua, MD
INTERNAL MEDICINE SECTION Mary Cianfrocca, DO, Division Chief Shefali Birdi, MD Ivana Dzeletovic, MD Margaret Miller, MD Ronald Servi, DO PATHOLOGY SECTION Kevin McCabe, DO, Division Chief To learn more about our physicians at Banner MD Anderson in Gilbert , please visit BannerMDAnderson.com/OurPhysicians.