Saint Francis Cancer Treatment Center

Oncology Update01I S S U E

J A N U A R Y2 0 1 3

B r i n g i n g t h e b e s t c a n c e r c a r e t o y o u r c o m m u n i t i e s

Happy New Year!Welcome to our first edition of the Saint Francis hematology-oncology newsletterWe are very proud and happy to share with you our first issue of the Saint Francis Hematology-Oncology Newsletter. This is a new quarterly newsletter produced by the physicians and staff of the Saint Francis Cancer Treatment Center in Grand Island and Hastings. We have designed it with you in mind as a way to stay in touch and to send updates about what’s happening in the world of hematology/oncology as well as at the Saint Francis Cancer Treatment Center.

Our cancer program has been a leader in prevention, diagnosis, treatment, research and education in hematology and oncology for the last 20 years. Our goal is to bring you information and updates about new preventative, diagnostic, therapeutic, supportive and palliative care related

developments, FDA drug approvals, featured clinical trials, and news from our cancer center, prioritizing the data that is practice-changing. In this issue we have presented practice-changing data in the treatment of Polycythemia Vera, breast cancer, and prostate cancer.

We will share with you a wide range of hematology oncology-related care topics that are both relevant and beneficial in the care of our shared patients. We hope that you find our newsletter helpful and informative. Thank you for your support over the past 20 years.

For more detailed information on any of the topics presented, please feel free to contact Dr. Copur at (308) 390-3493 or mcopur@sfmc-gi.org.

in this issue• Study Explores Why Double Mastectomy

Rate is on the Rise

• Ten Years of Tamoxifen Reduces Breast Cancer Recurrences, Improves Survival

• Cardiovascular Events and Intensity of Treatment in Polycythemia Vera

• Abiraterone Approval Extended to Treat Late-Stage Prostate Cancer

Dr. Melhem Jabbour • Dr. M. Sitki Copur • Dr. Ryan Ramaekers

GRAND ISLAND & HASTINGS, NEBRASKA

The Saint Francis breast cancer nurse navigator is available to every breast cancer patient immediately following diagnosis. The navigator’s job is to guide your patients through the process of planning and completing treatment. They help breast cancer patients find answers to their questions and give them the one-on-one support they need to make decisions. The navigator also acts as a liaison between the patient and the multidisciplinary care team, helping to coordinate care and making sure the patient understands all the information presented.

The nurse navigator services are provided free of charge, and patients may utilize navigation services as much or as little as needed. If the patient wishes, a navigator can accompany the patient to consultations to take notes. They will also connect patients to support services such as support groups, financial services, or family counseling.

Breast Cancer Nurse Navigation

2010 Outstanding Achievement Award

Study Explores Why Double Mastectomy Rate Is on the RiseMore women are choosing double mastectomy despite lowrisk of developing cancer in the unaffected breast.

Kicking the habitSaint Francis Cancer Treatment Center offers tobacco cessation classes to its patients, and anyone in the community who wants to quit using tobacco.

The Freedom From Smoking® program was developed by the American Lung Association, and teaches participants how to quit in a supportive setting.

The seven-week, eight-session program is lead by Cancer Treatment Center staff members Ann Tvrdy, MSN, CRNI, and Connie Hameloth, RN, who are both certified facilitators.

“Freedom From Smoking® was developed by a team of physicians, psychologists and health educators,” Hameloth said. “Over the past 25 years, it has been continually tested, updated and improved, so participants can feel confident that they are receiving the best possible assistance from a top-rated program.”

If you have a patient who is interested and could benefit from this program, please contact Ann or Connie at (308) 398-5450 for information on upcoming classes.

For some women with breast cancer, taking adjuvant tamoxifen for 10 years after primary

treatment leads to a greater reduction in breast cancer recurrences and deaths than taking the drug for only 5 years, according to the results of a large international clinical trial presented at San Antonio Breast Conference.

The findings from the ATLAS trial likely to change clinical practice. Nearly 7,000 women with early-stage, estrogen receptor-positive breast cancer were enrolled in the trial between 1996 and 2005. After taking tamoxifen for 5 years, participants were randomly assigned to continue taking tamoxifen for another 5 years or to stop taking it.

Among the women who took tamoxifen for 10 years, the risk of breast recurrence was 25 percent lower than it was among women who took it for 5 years, and the risk of dying from breast cancer was nearly 30 percent lower. There was no substantial increase in serious side effects, including endometrial cancer incidence or death, in women who took tamoxifen for the longer period.

The absolute increased risk of death from endometrial cancer in women who took tamoxifen for 10 years versus 5 years was 0.2 percent. The ATLAS results may l have a major, immediate impact on premenopausal women with early-stage, estrogen receptor-positive breast cancer.

Source: Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomized trial. The Lancet, Early Online Publication, 5 December 2012 doi:10.1016/S0140-6736(12)61963.

Ten Years of Tamoxifen Reduces Breast Cancer Recurrences, Improves Survival

New results from a population-based study, presented November 30 at the American Society of Clinical Oncology’s (ASCO) Quality Care Symposium in San Diego, show that about 75 percent of women diagnosed with cancer in one breast who chose to have a double mastectomy did so despite being at low risk of developing a new cancer in the unaffected breast.

Greater degree of worry about cancer recurrence was associated with contralateral prophylactic mastectomy (CPM). Only a small percentage of women diagnosed with breast cancer have clinical risk factors known to increase their chances of developing a new cancer in the unaffected breast—that is, mutations in the BRCA1 or BRCA2 genes and/or a strong family history of breast or ovarian cancer. Yet several studies show that rates of CPM among U.S. women with breast cancer are rising.

Out of 1,500 ethnically and racially diverse women diagnosed with breast cancer that had been reported to the Detroit and Los Angeles SEER registries 564 women received unilateral mastectomies and 107 opted for CPM. The remaining women had breast conserving surgery.

Women who reported that they had tested positive for BRCA1 or BRCA2 mutations were about 10 times more likely to undergo CPM than those who did not have a mutation, and those having two or more first-degree relatives with breast cancer were about 4.5 times more likely to undergo CPM than those who did not have a strong family history of the disease. Women who reported being “very worried” about recurrence were about twice as likely to have CPM as those who reported being “somewhat worried” or “not at all worried.”

Source: Is Contralateral Prophylactic Mastectomy (CPM) Overused? Results From a Population-Based Study. ASCO Quality Care Symposium [Abstract 26] Nov 2012.

Practice-changing Data

Current treatment recommendations for patients with Polycythemia Vera call for maintaining a hematocrit of less than 45%, but this therapeutic strategy has not been tested in a randomized clinical trial until recent presentation at the American Society of Hematology, December 2012.

365 adults with JAK2-positive Polycythemia Vera who were being treated with phlebotomy, hydroxyurea, or both randomized to receive either more intensive treatment (target hematocrit, <45%) (low-hematocrit group) or less intensive treatment (target hematocrit, 45 to 50%) (high-hematocrit group).

The primary composite end point was the time until death from cardiovascular causes or major thrombotic events. The secondary end points were cardiovascular events, cardiovascular hospitalizations, incidence of cancer, progression to myelofibrosis, myelodysplasia or leukemic transformation, and hemorrhage.

After a median follow up of 31 months an intention-to-treat analysis showed that the primary end point plus superficial-vein thrombosis occurred in 4.4% of patients in the low-hematocrit group, as compared with 10.9% in the high-hematocrit group (hazard ratio, 2.69; 95% CI,1.19 to 6.12; P = 0.02). Progression to myelofibrosis,

myelodysplasia or leukemic transformation, and bleeding were observed in six, two, and two patients, respectively, in the low-hematocrit group, as compared with two, one, and five patients, respectively, in the high-hematocrit group. There was no significant between-group difference in the rate of adverse events.

This study will be changing our practice in patients with Polycythemia Vera. A hematocrit target of less than 45% has a significantly lower rate of cardiovascular death and major thrombosis than those with a hematocrit target of 45 to 50%.

Source:Cardiovascular Events and Intensity of Treatment in Polycythemia Vera N Engl J Med 368;122 org January 3, 2013.

Abiraterone Approval Extended to Treat Late-Stage Prostate Cancer

Cardiovascular Events and Intensity of Treatment in Polycythemia Vera

A Time to Heal12-Week Holistic Cancer Rehabilitation Program

A Time to Heal is a 12-week holistic rehabilitation program designed to help people regain their physical, emotional and spiritual health after cancer treatment. The program is offered in two different class formats - an all cancers group which is open to men and women who have completed their cancer treatment, and a second group specifically for women who have had breast cancer.

Classes at Saint Francis Cancer Treatment Center meet for three hours weekly, and cover topics like nutrition, regaining strength, coping, relationships, relaxation, spirituality and happiness. Research and experience have shown that individual components of A Time to Heal make a positive difference in the well-being of cancer survivors.

The breast cancer class is led by Jacque Langford, BSN, CBPN-IC, and Mary Ann Kalinay, MS, LMHP. A Time to Heal for all cancers is led by Connie Hameloth, RN. All instructors are certified facilitators.

For more information on A Time to Heal, please contact the Cancer Treatment Center at (308) 398-5450.

Men with castration-resistant prostate cancer that has spread

can now be treated with abiraterone acetate (Zytiga) before receiving chemotherapy.

The Food and Drug Administration (FDA) expanded the approved use of abiraterone on December 10. The FDA initially had approved abiraterone in April 2011 for use in patients whose prostate cancer had progressed after treatment with the chemotherapy docetaxel.

Abiraterone is a pill that reduces testosterone production. However, castration-resistant cancers continue to grow even when levels of testosterone are very low. Abiraterone is designed to treat these tumors

by inhibiting the production of androgen in the testes, adrenal glands, and prostate cancer tumors themselves.

Abiraterone’s safety and efficacy for its expanded use were established in a clinical study of 1,088 men with late-stage castration-resistant prostate cancer who had not previously been treated with chemotherapy. Participants received either abiraterone or a placebo (both in combination with the corticosteroid prednisone). Patients who received abiraterone had a 25 percent decrease in the risk of death. Study results also showed abiraterone improved Progression Free Survival (PFS,) 16.5 months for patients treated with abiraterone versus 8.3 months in the placebo group.

Source: Abiraterone in Metastatic Prostate Cancer without Previous Chemotherapy N Engl J Med 2012.DOI: 10.1056/NEJMoa1209096.

Practice-changing Data

Practice-changing Data

C O N TAC T I N F O R M AT I O N Saint Francis Cancer Treatment Center2116 West Faidley AvenueGrand Island, NE 68803(308) 398-5450ht tp : / / sa in t f ranc i sg i . o rg

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Oncology Update Issue 01 January 2013

Providers:M. Sitki Copur, MD, FACP

Medical Director of Oncology

Melhem Jabbour, MD

Ryan Ramaekers, MD

Rita Hays, APRN, AOCNP

Deborah Nelson, APRN, AOCNP

Megan Schriner, PA

Clinical Trials:

Courtney Fuller, RN, OCN, CCRPMary Gulzow, CRA, CCRPRebecca Hadenfeldt, BSNJennifer Scott, BSN, OCNAlicia Wicht, CRA

Center for Translational Research Heather Benzel, RN, CCRP

Pharmacists:

Angie Obermiller, PharmDOncology Pharmacy Supervisor

Jon Olsen, PharmD

Mark Tharnish, PharmD

Navigators:Jacque Langford, BSN, CBPN-IC

Breast Cancer Nurse Navigator

Ashley Wissing, MAColorectal Cancer Navigator

Nutritionist

Maureen Hilderbrand, RD, LMNT

Genetic Counselors:Kim Brussow, CGC

Stephanie Percich, MS, CGC

Patient & Family Counselor:Mary Ann Kalinay, MS, LMHP

Oncology Project CoordinatorAnn Tvrdy, MSN, CRNI

Certified Tobacco Cessation Facilitator

Community Outreach CoordinatorConnie Hameloth, RN

Certified Tobacco Cessation Facilitator

Tumor Registry

Leslie Mlinar, CTRPatty Tripp, CTR, RHIT

Management:Max Norvell, PharmD

Director of Oncology

Mary Mickey, RN, OCNClinical Manager, Medical Oncology

Marlene Hinrichs, MA (R) (T)Clinical Manager, Radiation Therapy

Meet our team

Locations:

Saint Francis Cancer Treatment Center2116 West Faidley AvenueGrand Island, NE 68803(308) 398-5450

Saint Francis Cancer Treatment Center2nd Street & Marian RoadHastings, NE 68901(402) 461-5588

Visit us online:

SaintFrancisGI.org