In this issue

Issue No. 27 / May 2013

cancerupdate

(continued on back page)

Helen F. Graham Cancer Center pioneers clinical immersion program for engineering students

“Our goal was to introduce future bio-medical engineers to the problems thatneed solutions in today’s operatingroom,” said Surgical Oncologist Joseph

Bennett, M.D., who led a four-week clinical immer-sion session in January 2013 for University of Delaware (UD) students. “In just one month, the

students came up with some very good ideas,” he said.

Eleven students took the course, offered in partnership with clinicians and profes-sionals at Christiana Care, Nemours/Alfred I. duPont Hospital for Children and the Infant Behavior Laboratory atUD’s Early Learning Center. The coursechallenged students to find potential solutions for unmet clinical needs.

“This unique clinical immersion session is a model for similar cooperative learning experiences,” said Nicholas J. Petrelli, M.D.,Bank of America endowed medical director of the Helen F. Graham

Cancer Center.

Director’s Corner: The Last Piece of the Puzzle

Screening Program Breaks Down Racial Barriers

New Residency in Medical Physics

Building Mental Health Programs for Cancer Survivors

Safeguarding Patients’ Rights

Dr. Bennett demonstrates a procedurewith University of Delaware studentsAnna Sung, left, and Madison DeFrankin the Virtual Education and SimulationTraining Center.

IN A FIRST-OF-ITS-KIND PROGRAM IN THE NATION, cancer specialists at theHelen F. Graham Cancer Center are closing the gap between the real world and the classroom for tomorrow’s biomedical engineers.

This year, the Friends of the Helen F.Graham Cancer Center celebrate their10th anniversary. Thanks to the philan-thropic efforts of these dedicated lead-ers, significant resources have beenraised to support our program, and I amdeeply grateful. We have also benefittedfrom the generosity of the Junior Boardof Christiana Care, many communitybusinesses, foundations and numerousindividuals throughout our region. As aresult, we have been able to raise thebar on cancer care for Delawareans inmany ways:

• Multidisciplinary disease site centerswhere patients meet their specializedcancer care team in one visit.

• The Ruth Ann Minner High-Risk Family Cancer Registry, made possible by a generous grant from AstraZeneca, offers statewide geneticcounseling and gene testing, the ultimate in cancer prevention andearly detection.

• An expanded cancer outreach program for the underserved.

• A premier National Cancer Instituteand pharmaceutical clinical trialsprogram, nurse navigators, pain andpalliative care, wellness, social andpsychology experts, research nursesand a Department of Radiation Oncology at the technological forefront.

One puzzle piece is still missing —adequate resources to secure the future of the Center for TranslationalCancer Research (CTCR). This 7,000square-foot, state-of-the-science labora-tory, in the Graham Cancer Center’sWest Pavilion, is unique to our commu-nity. The CTCR was founded on a stronginfrastructure of collaboration betweenGraham Cancer Center clinicians andscientists at the University of Delaware,Delaware State University, the Wistar Institute in Philadelphia, the NemoursResearch Institute/A.I. duPont Hospitalfor Children and the Kimmel CancerCenter at Thomas Jefferson University.Our work is transforming the culture ofcancer research into a powerhouse ofmultidisciplinary teams and a synthesisof ideas, technologies and research focused on the common goal of curingand preventing cancer. Our ultimate success requires time and no small sumof resources.

The CTCR offers the capability to conduct highly complex studies; to develop new diagnostics, drug productsand new medical knowledge; to createjobs; to attract quality physicians; and totrain tomorrow’s clinical investigators.Exciting projects underway include researching colorectal cancer stem cells;mapping the pathways linked to cancercell development; designing artificial

salivary glands; and building nanofiberscaffolds to study breast cancer. Underthe direction of Eric Kmiec, Ph.D., aGenome Customization Core within the CTCR will create customized cell lines for drug screening and analysisthat better reflect genetic variances in our general population.

Completing the picture are the hard-working physicians, nurses and para-medical personnel who have tirelesslydevoted their time and expertise to bothinpatients and outpatients at ChristianaCare. In concert with our patient care and prevention programs, a secure andvibrant CTCR will be a lasting legacy forour generous supporters — and a brightpicture, indeed, for Delawareans whodo not have to leave our state for theircancer care.

Nicholas J. Petrelli, M.D., Bank of America endowedmedical director of the Helen F. Graham Cancer Center,lays out the pieces to a multifaceted Cancer Program.

D I R E C T O R ’ S C O R N E R

NICHOLAS J . PETRELL I , M .D .

2 Christiana Care Health System

The Last Piece of the Puzzle

Cancer Update 3

Successful colorectal cancer screening program breaks down racial barriers in DelawareReport by Stephen Grubbs, M.D., and Nora Katurakes, RN, featured in Journal of Clinical Oncology

DELAWARE’S SUCCESSFUL EFFORTS to eliminate the racial disparity in colon cancer between African-Americans and whites is the focus of an article by lead co-author Stephen Grubbs, M.D., an oncologist at the Helen F. Graham Cancer Center, and Nora Katurakes, RN, MSN, OCN, Christiana Care’s managerof Community Outreach and Education. The article,“Eliminating Racial Disparities in Colorectal Cancer inthe Real World: It Took a Village,” is featured in theApril issue of the Journal of Clinical Oncology.

“We demonstrated what can happen when the state’s entire health care community mobilizes toward a common goal,” said Dr. Grubbs, who is also a member

of the Delaware Cancer Consortium. “The First State isthe first state to show that they have eliminated a health disparity statewide.”

Colorectal cancer is the third most common cancer in the U.S., but highly preventable with routine screening.Using a multi-pronged approach, Christiana Care’s Helen F. Graham Cancer Center partnered withDelaware’s other hospitals, providers and state govern-ment to save lives from colorectal cancer, targeting theunderserved at greatest risk. The state-run Screening forLife program and the Delaware Cancer Treatment Program helped cover the costs.

The findings show the percentage of colorectal cancercases diagnosed at advanced and regional stages among African-Americans declined from 79 percent to 40 percent. Overall incidence rates per 100,000 also declined from 67 to 58 percent for African-Americans and whites, respectively in 2002 to 45 percent for both in 2009.

Nurse navigators at Christiana Care and other health systems recruited both insured and uninsured patients for cancer screening and coordination of care. From 2004 to 2011, the program provided more than 10,000navigations and 5,000 colorectal cancer screenings.

“The First State is thefirst state to show thatthey have eliminated a health disparitystatewide.”

—STEPHEN GRUBBS , M .D .

Nora Katurakes, RN, MSN, OCN, manager of CommunityOutreach and Education, explains the benefits of colorectalcancer screening at a recent event.

4 Christiana Care Health System

The first candidate accepted into the new medical physicsresidency at Christiana Care is Allison Mitchell,whoholds a master’s degree in medical physics from DukeUniversity. She begins clinical rotations in July 2013,pending program certification by the Commission onAccreditation of Medical Physicists EducationalPrograms (CAMPEP), Inc.

As a branch campus of Jefferson Medical College and anindependent academic medical center, Christiana Caresupports 13 residency programs. The new medicalphysics residency at the Helen F. Graham Cancer Centeris the first for allied health professionals.

“Our ability to partner with Jefferson to offer accreditedradiation oncology physics residency trainingstrengthens our vision to provide quality education aswell as excellent clinical practice to our community,” said Radiation Oncology’s Chief of Clinical Physics Firas Mourtada, MSE, Ph.D., D.ABR,who will serve as associate program director.

Innovative teaching modelMedical physicists collaborate with radiation oncologiststo help plan and supervise the delivery of complexradiation treatments for cancer patients. Using aninnovative teaching model, Jefferson’s CAMPEP-accredited, two-year medical physics residency programwill serve as the “hub,” offering courses for the residentson campus in Philadelphia with many sessions availableonline. The Helen F. Graham Cancer Center will be the“spoke” or affiliate, offering residents the opportunity towork alongside our radiation oncologists, medicalphysicists and dosimetrist using the latest radiationoncology technologies.

According to Dr. Mourtada, “With this training model,we maximize the complementary strengths of our twoinstitutions.” For example, nationwide we are among thebusiest for high-dose-rate brachytherapy for breast andgynecological cancers, low-dose-rate brachytherapy forprostate cancer, and the highly advanced Cyberkniferobotic radiosurgery system, which is currently notavailable at Jefferson.

Radiation Oncology launches first allied health residency in medical physics

THE CHRISTIANA CARE DEPARTMENT OF RADIATION ONCOLOGY AT THE HELEN F. GRAHAMCANCER CENTER OFFERS ITS F IRST RESIDENCY PROGRAM IN MEDICAL PHYSICS. The program is in collaboration with the Thomas Jefferson University Radiation Oncology Department Division of MedicalPhysics at the Kimmel Cancer Center in Philadelphia.

Dr. Mourtada and Dayee Jacob, senior medical physicist,work on a brachytherapy treatment plan.

Cancer Update 5

“We want to change the culture of thinking about mentalhealth and how we communicate with cancer survivorsto get them the help they need,” said Health PsychologistScott D. Siegel, Ph.D.

Dr. Siegel led the NCCCP Survivorship & Palliative Care Subcommittee working group to develop a CancerPsychosocial Care Matrix. Theresa Gillis, M.D., medicaldirector of Oncology Pain and Symptom Managementand Rehabilitation Services at the Graham Cancer Center, was in the working group and a co-author on itspaper published online in Psycho-Oncology 2013.

“As a member of the NCCCP, we share a common goalof improving cancer care for our patients in their homecommunities,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F.Graham Cancer Center. “Collaborating to develop bettertools to facilitate better care and modeling best practicesfrom our own experiences are important elements of this successful partnership that will benefit the entire national community of cancer centers.”

Roadmap for improvement

According to Dr. Siegel, national practice guidelines emphasize the importance of providing distress screen-ing for cancer survivors, improving communication between providers and patients, and offering interven-tions or referrals for mental health and social services.However, he acknowledges that guidance about how tomake the vision a reality among cancer centers with diverse capabilities and resources is limited.

“The matrix can help community cancer centers evaluatetheir own programs and provide measureable mile-stones to close any gaps to care,” he said. This roadmapcan be a conduit to more comprehensive psychosocialservices for patients at individual centers, especiallywithin the context of changing Commission on Canceraccreditation standards.

Graham Cancer Center models psychosocial program development for cancer centers across the country

NEW STUDY EXAMINES SURVIVORS’FEAR OF RECURRENCE

A two-year grant from the National Cancer Institute supports Dr. Siegel’s research in collaboration with the University ofDelaware’s Professor Jean-Philippe Laurenceau, Ph.D., which studies fear of recurrence in breast cancer patients and theirspouses or partners. “From our prior research,we know fear of recurrence is common, attimes debilitating, and under-recognized problem facing survivors,” Dr. Siegel said. In this new study, the investigators examinefactors that exacerbate and attenuate fear ofrecurrence and its emotional toll on familymembers as well. Their clinical findings potentially will enhance standards of care for cancer survivors.

AS A NATIONAL CANCER INSTITUTE SELECTED COMMUNITY CANCER CENTER PROGRAM(NCCCP), the Helen F. Graham Cancer Center is working with other centers — nationally — to build effective psychosocial programs for cancer survivors.

Dr. Siegel counsels a patient at theHelen F. Graham Cancer Center.

6 Christiana Care Health System

AT 23 PERCENT, Christiana Care’sHelen F. Graham Cancer Center hasone of the highest patient accrual ratesfor cancer clinical trials in the U.S., farabove the national average of 5 percent.

The Christiana Care Institutional Review Board (IRB) represents the interests of patients who participate in cancer clinical trials and safeguardstheir rights and welfare. The IRB alsoensures compliance with all federaland state regulatory requirements andethical principles and reports to theQuality and Safety Committee of theChristiana Care Board of Directors.

Twenty members, volunteers frommultiple medical disciplines and thecommunity, serve on one of two IRBcommittees chaired by Gary Johnson,Ph.D., and Steven Kushner, M.D.

All research that involves human subjects or their data at Christiana Caremust be approved by the IRB. Accord-ing to IRB Director Jerry Castellano,Pharm.D., CIP, cancer research trials

constitute a significant percentage ofthe IRB workload. The Christiana CareIRB also reviews and approves cancerresearch trials for protocols conductedat hospital affiliates of Christiana Care's Community Clinical OncologyProgram (CCOP) at the Helen F. Graham Cancer Center.

Institutional Review Board safeguards patient rightsin cancer clinical trials

Beverly Cusano, MHA, joinedChristiana Care as director ofRadiation Oncology in August2012. She replaces former directorWilliam Holden, MBA, RN, RT,(T), (R),who is now Vice Presidentof the Helen F. Graham CancerCenter.

As director, Ms. Cusano hasoversight for all RadiationOncology operations at theGraham Cancer Center andChristiana Hospital as well as atsatellites in Elkton, Md., and

North Wilmington, Del. She has extensive experience inhealth care administration, having worked most recently (2009-2012) as director of Radiation Oncology for BaptistMemorial Hospital in Memphis, Tenn. Her background asa radiation therapist, coupled with her master’s degree inhealth administration, gives her a patient-centricperspective of the radiation therapy process.

Cardiothoracic Surgeon Brian T. Nam, M.D., joined theThoracic/Esophageal Cancers multidisciplinary team atthe Helen F. Graham Cancer Center following fellowshiptraining in his specialty at the University of Wisconsin,Madison. He received his medical degree from theUniversity of Minnesota and competed residency trainingin general surgery at the Mayo Clinic in 2010.

Dr. Nam specializes inminimally invasive treatmentsfor esophageal and lungcancers including video-assisted thoracic surgery and minimally invasiveesophagectomy. His researchincludes using “fast track”standardized protocols topromote faster recovery andshorter hospital stays.

Meet our new team members

THE IRB TEAM, FROM LEFT: Sonia Martinez-Colon, executiveassistant; Jerry Castellano, BS, Pharm.D,CIP, corporate director; Lauren Pigeon,CPhT, administrative assistant II; JanetLeary-Prowse, MSEd, CIP, researcheducation specialist; Heidi Derr, CIP,regulatory affairs and auditing specialist;and Judy Hutt, administrative assistant.

Cancer Update 7

Society of Surgical Oncology’s “Great Debates” featured Nicholas Petrelli, M.D.,Bank of America endowed medical director of the Helen F. Graham CancerCenter, versus Mitchell C. Posner, M.D., chief of general surgery and surgicaloncology from the University of Chicago, during the society’s 66th Annual Cancer Symposium, on March 9. Their topic: “Surgery Alone Versus Surgery Plus Chemotherapy for Resectable Colorectal Liver Metastases.” Dr. Petrelliargued in favor of surgery alone; Dr. Posner argued in favor of both surgery and chemotherapy.

“The real crux of the matter here is surgical resection and avoiding the toxicityand the cost of these agents, which have absolutely no impact on overall survivalas shown by prospective randomized trials,” Dr. Petrelli said during the debate.Treatment at the Graham Cancer Center is based on national guidelines andtailored to what is most appropriate for each individual patient, whether it issurgery alone or in combination with chemotherapy.

The Helen F. Graham CancerCenter’s Care Management Teamwon the American PsychologicalAssociation’s (APA) PsychologicallyHealthy Workplace Award 2013,

for creating a healthy, high-performance work environment. Theteam is also an APA Best Practices honoree for employee growthand development. Christiana Care is only the fourth hospitalsystem ever to win the national award and is one of only fouremployers in North America to receive the award this year.Cancer Care Management previously won the DelawarePsychological Association’s state-level Psychologically HealthyWorkplace Award, qualifying for APA award nomination.

This just in

Members from Cancer Care Management accepted the awardat APA’s 8th Annual Psychologically Healthy Workplace AwardCeremony on March 9 in Washington, DC.

Among the 100 top hospitals with “Great Oncology Programs,” Christiana Care and the Helen F. Graham Cancer Center rank among the best for clinical accolades,quality care and contributions to the field of oncology, according to Becker’s Hospital Review.

Congratulations to RadiationOncology’s Chief of ClinicalPhysics Firas Mourtada,MSE., Ph.D., D.ABR, who isthe newly elected treasurerand member of the Board of Directors of the AmericanBrachytherapy Society, 2014-2016.

Helping Hands for Breast Health at the Helen F. GrahamCancer Center won a one-year, $50,000 grant from theAvon Breast Health Outreach Program. Now in its 12th yearof Avon funding, the program has reached more than 8,000New Castle County area women and referred them for low-cost or free mammograms and clinical breast exams in their own communities.

Christiana Care’s Chief of Thoracic SurgeryThomas L Bauer, M.D.,is the 2013 president of the PhiladelphiaAcademy of Surgery, the oldest surgical societyin the U.S. Dr. Bauer, whosees patients at the HelenF. Graham Cancer Center,

is a National Institutes of Health-funded clinical trialsprincipal investigator, working to advance the treatment oflung and esophageal cancer.

Cancer Update is produced by Christiana Care Health System. Entire publication © Christiana Care Health System, 2013. All rights reserved. 13CANC57

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

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

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

National Cancer Institute CommunityCancer Centers Program.

Non-Profit Org.US Postage

PAIDWilmington, DEPermit No. 357

“What better way to allow biomedical engineering studentsto think outside the box than to place them in a health careenvironment to benefit patient treatment?”

Operating room becomes classroomThe Graham Cancer Center hosted UD juniors Madison DeFrank and Anna Sung,who shadowed 10 different specialists and gained exposure to surgical oncology techniques, medical devices and instrumentation in the operating room. Their mission was to observe, identify anddevelop potential solutions to some of cancer surgery’smost intricate and pressing technical challenges.

The students presented their ideas to participating facultyand industry sponsors at the Nemours/A.I. duPont Hospi-tal for Children on Jan. 31 during a poster session fundedby the Delaware Health Sciences Alliance. Proposed inno-vations included a biodegradable suture delivery system, awaterproof sealant to close incisions, a “belly cam” to view

the inner abdomen, an automated “twitch” monitor for patients under anesthesia and a pill-sized camera for takingpictures inside the digestive tract. Several students areeager to transform their ideas into formal senior designprojects next year.

Jill Higginson, Ph.D., associate director of UD’s BiomedicalEngineering Program, conceived the idea for the courseand secured the student placements with the help of David Martin, Ph.D., Karl Bõer Chair of UD’s Departmentof Materials Science and Engineering.

Christiana Care participating specialists included surgeons,Thomas Bauer, M.D., Michael Conway, M.D., RaafatAbdel-Misih, M.D., Michael Peters, M.D., Bhaskar Rao, M.D., and Jeffery Zern, M.D.; gynecologic oncologistMark Cadungog, M.D.; vascular and interventional radiologist Mark Garcia, M.D and cardiologist Michael Stillabower, M.D.

Virginia LoosExecutive Assistant

“Part of my job is making sure the Graham Cancer Center is a safe andinviting environment for everyone who walks through our doors. Above all,I’m here to provide direct support to the physicians and nurses so they canstay focused on what’s most important – our patients.”

FEATURED EMPLOYEE

Helen F. Graham Cancer Center pioneers clinical immersion program for engineering students(continued from front)