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© Green Hill Healthcare Communications MARCH 2017 www.TheOncologyNurse.com VOL 10, NO 2 CANCER CENTER PROFILE Direct Access to Colonoscopy Massachusetts General Hospital Improves Screening Rates, Cancer Center: Survivorship Adenoma Detection Initiative for Patients Who Have By Wayne Kuznar Undergone Bone Marrow Transplant San Francisco, CA—A Direct Access ity for the program and provides in- Screening Colonoscopy (DASC) pro- structions for bowel preparations, said gram at Advocate Illinois Masonic Gabriel Rodriguez, MD, resident, Ad- Medical Center in Chicago was found vocate Illinois Masonic Medical Cen- to increase the overall screening rate for ter, at the 2017 Gastrointestinal Can- colorectal cancer (CRC) by almost cers Symposium. 100% without excess complications. CRC is a highly preventable disease if The program is run by a nurse naviga- detected early. Despite efforts to inform tor, who questions patients over the the public about the clear benefit of telephone to determine patient eligibil- CRC screening, the majority of the pop- CommunicationsContinued on page 8 The Mass General Bone Marrow Transplant Survivorship Program team (left to right): Areej El-Jawahri, MD; Julie Vanderklish, NP. Autologous Breast Reconstruction Has Better he Mass General Cancer Center is an integral part of a top-flight academ- ic medical center: Massachusetts General Hospital. The Mass General Outcomes Than Implants in TCancer Center is among the leading cancer care providers in the United States, and is a National Cancer Institute–designated comprehensive cancer Patients Receiving Radiotherapy center as part of the 7-member Harvard Medical School consortium. This con- Continued on page 7 By Phoebe Starr San Antonio, TX—The largest study to “The benefits of radiation for selected Reducing Disparities in date comparing outcomes of radiation women with breast cancer are well- therapy and postmastectomy breast re- established. Updated guidelines recom- Survivorship Care Healthcareconstruction found higher rates of com- mend individual consultations for plication and failure in women who women who want breast reconstruction. By Chase Doyle received radiation therapy and had im- Breast reconstruction has a significant plant reconstruction versus autologous impact on survivors. The integration of San Diego, CA—Surviving cancer is cancer and its treatment; concerns re- reconstruction. These data have been radiation and reconstruction is widely the start of a new journey for many in- Hilllated to employment, insurance, and long-awaited, because there are no firm feared and poorly understood, with only dividuals. Cancer survivors face a mul- disability; and coordination between guidelines, and more women are being limited evidence to date,” said Reshma titude of challenges, including preven- specialists and primary care providers. treated with radiotherapy. Jagsi, MD, DPhil, Deputy Chair, Depart- tion of new and recurrent cancers; These challenges are compounded Continued on page 18 interventions for illnesses secondary to when trying to ensure the appropriate, INSIDE Continued on page 12 8 Colorectal Cancer 16 Lung Cancer Daily moderate exercise can improve Managing immune-related toxicities in outcomes in patients with metastatic patients with lung cancer Green colorectal cancer 18 Breast Cancer 10 Genetic Counseling Specific menopausal symptoms New data suggest the benefit of associated with nonadherence to © multigene panel testing for patients hormonal therapy in women at risk with early-onset colorectal cancer for breast cancer 13 Survivorship 22 Pancreatic Cancer Internet-generated survivorship Duloxetine improves chemotherapy- care plans are convenient and induced peripheral neuropathy in customized patients with pancreatic cancer © 2017 Green Hill Healthcare Communications, LLC CANCER CENTER PROFILE Massachusetts General Hospital Cancer Center: Survivorship Initiative for Patients... Continued from the cover sortium forms the largest research col- TON: What does the initial laborative in the country, and has par- assessment entail? ticipated in developing promising new Ms Vanderklish: It takes approximately treatments that have revolutionized the 4 hours to complete a survivorship con- treatment of cancer. sult. We approach a survivorship visit by The Mass General Cancer Center first reviewing the patient’s diagnosis, provides customized multidisciplinary cancer treatment (including BMT), side care to children and adults. In addition effects, and medical history. Next, Dr to medical oncology, surgical oncology, El-Jawahri or myself meet with the pa- and radiation oncology, the cancer cen- tient, which takes approximately 60 to ter offers a full range of cancer care– 90 minutes. After that, we write an indi- related programs. vidualized survivorship care plan in the These include the Katherine A. Gal- longitudinal medical record and discov- lagher Integrative Therapies Program, er our recommendations with the BMT which offers free wellness programs for team, primary care physician, and the patients and their caregivers; the Life- Julie Vanderklish, NP Areej El-Jawahri, MD patient. This takes approximately 4 to 5 style Medicine Clinic for patients and hours. Our patients also meet with the survivors who want a personalized con- Our goals are to als, and methods for communicating social worker for 1 hour to process the sultation to improve their overall phys- with BMT specialists, primary care BMT experience, and with a program ical fitness and quality of life; a sexual provide high-quality physicians, and patients. We worked nurse to review things such as diet, exer- health clinic; the Marjorie E. Korff survivorship care, with excellent social workers and psy- cise, infection prevention, and educa- PACT program, which offers psychoed- chologists in developing the psychoso- tion about chronic GVHD. ucational support for patients who are conduct innovative cial component of our program and parents; and the Center for Psychiatric support services. TON: How did your career Oncology and Behavioral Sciences, research specific to path lead to caring for which helps patients cope with the psy- BMT survivorship, and TON: This soundsCommunications like a time- patients who have had BMT? chological and behavioral impact of consuming effort. Ms Vanderklish: During nursing their cancer. improve the quality of Ms Vanderklish: Yes, it took us more school at Northeastern University, Bos- The Mass General Bone Marrow life and care of BMT than 1 year, working part-time approxi- ton, MA, one of my cooperative work/ Transplant (BMT) Survivorship Pro- mately 10 to 20 hours per week, to de- study programs was at Dana-Farber gram is a new initiative specifically de- survivors, their families, sign the program. Cancer Institute, Boston, in the BMT signed to improve the lives of patients inpatient unit. I fell in love with trans- who have undergone BMT. The pro- and caregivers. TON: Did you and Dr plant and the patients I met there. gram features several unique compo- —Julie Vanderklish, NP El-Jawahri have any help in Since then, except for a brief hiatus nents that address the various aspects of laying the groundwork? to have my children, I have always BMT survivorship, and is open to pa- cialists, medical experts, palliative care, Ms Vanderklish: Dr El-Jawahri and I worked with BMT patients. After tients who are ≥1 years post-BMT. and support for sexual health and psy- did most of the groundwork. However, working at Massachusetts General Hos- The Oncology Nurse-APN/PA (TON) chosocial issues. we received guidance and support from pital on the inpatient BMT floor, I spoke with Julie Vanderklish, NP, about many local experts in BMT and chron- wanted to be able to expand my role in the comprehensive efforts involved in TON: How did you go about ic graft-versus-host disease (GVHD), transplant. So I went back to school to planning the program and bringing it to designing the program? such as Nathaniel Treister, DMD, become a nurse practitioner. I have fruition. Ms Vanderklish is co-leader of Ms Vanderklish:Healthcare We realized we first DMSc, Chief, Division of Oral Medi- been a nurse practitioner for 17 years the program under the directorship of needed to understand survivorship and cine and Dentistry, Brigham and Wom- within the Partners System at Massa- Areej El-Jawahri, MD, a BMT and pal- what it entails. We reviewed data on en’s Hospital, Boston, MA; Arturo P. chusetts General Hospital, Dana-Far- liative care specialist at the Mass Gen- the effects of cancer treatments and Saaverdra, MD, PhD, Medical Direc- ber Cancer Institute, and New- eral Cancer Center. BMT complications, as well as survivor- tor, Medical Dermatology, Massachu- ton-Wellesley Hospital. My main area shipHill recommendations from the Ameri- setts General Hospital; and many oth- of interest is chronic GVHD, a com- TON: What distinguishes the can Cancer Society, the American ers. Our superb social work, psychology, plex side effect of BMT that has a sig- BMT Survivorship Program Society of Clinical Oncology, the Na- nursing, and nurse practitioner teams nificant impact on quality of life. from other survivorship tional Institutes of Health, and the Na- were also very helpful. programs? tional Cancer Institute. We also met We performed a trial run that started TON: Have there been any Julie Vanderklish: As far as I am with directors of other BMT survivor- in July 2016. We saw 23 patients recent advances in the aware, there is a limited number of ship programs and then began our clin- through December and then reviewed management
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