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CAR T-Cell Therapy Now Offered at Nebraska Medicine

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After the T cells are collected from the patient, they are sent to a California lab to be restimulated to fight their own lymphoma. They are then returned to Nebraska Medicine to be reintroduced to the patient.

Seeking Patients with Relapsed B-Cell Lymphomas for Clinical Trial

It’s the fifth most common type of cancer for adults in U.S. For years, traditional therapies to treat non-Hodgkin’s lymphoma (NHL) have included chemotherapy, radiation and a stem cell/bone marrow transplant. For the first time, a promising new option will be offered at Nebraska Medicine called Chimeric Antigen Receptor (CAR T-Cell Therapy). It’s a way of taking the patient’s own immune system and modifying it to attack the cancer.

Dr_-Vose-135x190- Julie Vose, MD

“T cells are white blood cells that help our bodies fight infection and cancer,” explains Julie Vose, MD, chief of Hematology/Oncology. “In lymphoma patients, these cells have gone haywire. They don’t fight the cancer properly. This clinical trial will allow us to take the patient’s own T cells outside the body and restimulate them to be able to fight their own lymphoma.”

From start to finish, the entire process takes about three weeks. During the first phase, the patient’s T cells are collected during an outpatient procedure at the hospital. The cells are then sent to a lab in California for processing. In the meantime, the patient receives several days of intense chemotherapy. When the cells return to Omaha, they’re placed in a specialized processing center here to complete the procedure. The patient then has their own modified T cells given back to them. A specialized team monitors the patient at the hospital for the next 7-10 days, including frequent blood tests and exams.

“It’s a great opportunity for non-Hodgkin’s lymphoma patients who have failed every other therapy,” says Dr. Vose. “So far, this clinical trial has only been done in a few patients, but it looks very promising with high response rates.”

In the past, CAR T-Cell Therapy has only been offered at a few places, including Memorial Sloan Kettering Cancer Center in New York, University of Washington Medical Center in Seattle and the Hospital of the University of Pennsylvania in Philadelphia. Nebraska Medicine is one of the first hospitals in the Midwest to offer the clinical trial.

“This type of treatment can’t be done at just any hospital or center. It’s specialized with respect to what’s needed to collect and process the cells,” explains Dr. Vose. “We have a very large lymphoma program at Nebraska Medicine, which specializes in research and clinical trials. We’re hoping to attract patients from all over the region.”

The clinical trial is open to adult patients (19 years and older) with relapsed b-cell lymphomas, which is a subtype of non-Hodgkin’s lymphoma. Because the treatment is extensive, the patient must be in good enough shape. Some of the treatment aspects are paid for by the study. Dr. Vose is looking to attract 5-10 participants over the next year, but will take more if interest is high.

“Clinical trials are very important, especially when it comes to cancer. That’s the way we discover new treatments,” says Dr. Vose. “Everything we have today is because of clinical trials in the past. Without patients on clinical trials, we wouldn’t have any cancer treatments today or tomorrow.”

To sign up for Dr. Vose’s clinical trial, call Nebraska Medicine at 402-559-5600. To learn more about the upcoming clinical trial, watch the video below.

Nebraska ranks as 10th healthiest state

by Elizabeth Kumru, UNMC public relations

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Ali S. Khan, M.D., M.P.H., dean of the College of Public Health, traveled the state in 2014 to talk with stakeholders about how to improve the state’s health indicators. His goal is to have Nebraska rank as the healthiest state in the U.S. by 2020.

Ali S. Khan, M.D., M.P.H., dean of the College of Public Health, traveled the state in 2014 to talk with stakeholders about how to improve the state’s health indicators. His goal is to have Nebraska rank as the healthiest state in the U.S. by 2020.
Nebraska has moved into the top 10 among the healthiest states in the country.

In a report issued by the United Health Foundation earlier this month, Nebraska moved up one notch after ranking No. 11 last year. This marks the 25th year that UHF has issued state rankings.

About the rankings

America’s Health Rankings is the longest-running report of its kind. It provides analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socioeconomic data to determine national health benchmarks and state rankings. The rankings employ a unique methodology that is developed and annually reviewed and overseen by a Scientific Advisory Committee of leading public health scholars. It is published by the United Health Foundation in partnership with the American Public Health Association and Partnership for Prevention.

The data in the report come from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education, and the Census Bureau.

See the rankings in full.

Use dropdown menus to narrow or expand information.
“We are heading in the right direction,” said Ali S. Khan, M.D., M.P.H., dean of UNMC’s College of Public Health. “With a real concerted effort, we can reach No. 1 by 2020.”

Since joining UNMC in July, Dr. Khan has traveled across the state to talk about how to improve the state’s health indicators. He supports UNMC Chancellor Jeffrey P. Gold, M.D., and his strategic goal to work with all health systems and private and community partners to help make Nebraska the healthiest state in the union by 2020.

The report, “America’s Health Rankings: A Call to Action for Individuals and their Communities,” analyzed the health of the nation holistically with in-depth data and analysis. Its focus is on behaviors, community and environment, policy and clinical care to provide a comprehensive picture of the nation’s health. Indicators are: low birth weight, smoking, obesity, drug deaths, physical inactivity and adolescent immunizations.

First, the good news – Nebraska ranks:
•First – High rate of high school graduation. In the past two years, high school graduation increased 12 percent from 82.9 percent to 93 percent for incoming ninth graders. Nebraska is tied with Vermont for the highest graduation rate in the nation.
•Second – High immunization coverage among children. In the past year, immunization coverage among children increased by 9 percent from 72.6 percent to 79 percent for children aged 19 to 35 months.
•Third – Low rate of drug deaths.
•10th – In the past year, the number of children in poverty decreased by 27 percent from 19.6 percent to 14.3 percent.
•24th – In the past year, preventable hospitalizations decreased by 13 percent from 63.8 to 55.8 per 1,000 Medicare beneficiaries.

Still, it isn’t all good news.

In areas that need work, Nebraska ranks:
•16th – In the past two years, the percentage of adults with diabetes increased 10 percent from 8.4 percent to 9.2 percent.
•21st – Percentage of adults who are smokers (self-report smoking at least 100 cigarettes in their lifetime and currently smoke).
•23rd – Public health funding.
•27th – Percentage of adults who are obese.
•44th – Percentage of adults who self-report drinking alcoholic beverages on at least one occasion in the last month: women – four or more drinks at one sitting; men – five or more drinks at one sitting.

Dr. Smith attends State of the Union

Smith1118Philip Smith, M.D.

U.S. Sen. Ben Sasse hosted Philip Smith, M.D., medical director of the Nebraska Medicine Biocontainment Unit, as his guest at Tuesday night’s State of the Union Address. Dr. Smith, a professor of internal medicine-infectious diseases at UNMC, leads the specialized Nebraska team that treated three Ebola patients last year.

“By risking their lives for strangers, Nebraska’s biocontainment team inspired us to service above ourselves,” said Sen. Sasse. “The courage, precision, and hard work of these doctors, nurses, and medical professionals saved lives, educated health providers, and calmed public fears. Nebraskans are tremendously grateful for Dr. Smith’s team, and it is an honor to welcome him to Washington as a representative of Nebraska Medicine and UNMC’s dedicated staff.”

“I am deeply honored to have been invited by Sen. Sasse to attend the State of the Union Address. This is a tribute to all of our dedicated and skilled staff who make it possible for us to care for Ebola patients at the Nebraska Biocontainment Unit,” Dr. Smith said.

Nebraska Medicine’s Biocontainment Patient Care ‎Unit is the largest in the country and one of just three facilities in the United States equipped and trained to handle Ebola patients. Between September and November of last year, the world-class Biocontainment Unit successfully treated Dr. Rick Sacra and freelance journalist Ashoka Mukpo.

Nebraska Medicine and UNMC have established the gold standard in treatment of Ebola, Sen. Sasse said. Since the fight against Ebola began, the Biocontainment Unit staff has trained the staffs of more than 40 hospitals across the United States in how to safely handle and treat Ebola patients.

UNMC trial explores injectable HIV medications

by Kalani Simpson, UNMC public relations

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Study coordinator Angela Felton-Coleman performs an injection as study coordindator Frances Van Meter looks on.

Study coordinator Angela Felton-Coleman performs an injection as study coordindator Frances Van Meter looks on.
A potential new drug-delivery system, being tested in UNMC’s HIV Clinic as part of a clinical trial, might not only treat the condition, but offer additional peace of mind.

In a few decades, HIV has gone from being a death sentence to a chronic condition. These days, many of us who don’t have it think about it infrequently, if at all. But, those who have HIV have to think about it every time they swallow another pill.

But UNMC’s clinic is one of a handful of sites nationwide taking part in a clinical trial that tests the efficacy of getting periodic injections rather than taking pills.

“This is something that’s never been done before,” said Uriel Sandkovsky, M.D., assistant professor of internal medicine. “Injectable medicine is something we’ve been waiting for years.”

These injections, theoretically, last for long periods of time. So, you’re good for a good while. That way, there’s no forgetting to take your pills.

But, you can forget that you have to.

“It allows me to put that to the back of my mind,” said a clinical trial participant, who asked to remain anonymous. “I have had a lot of anxiety finding out that I was HIV-positive.”

And he would be reminded of that anxiety every time he took a pill.

But, getting two shots every four weeks? “For lack of a better term, I feel normal,” he said.

Susan Swindells, M.B.B.S., professor of internal medicine and the clinic’s medical director, is not surprised. A 2012 UNMC study told her much the same thing. Given a choice, many HIV-infected patients would prefer periodic injections instead of daily pills.

And, for many, it goes beyond convenience, or even peace of mind.

“Some have competing subsistence demands,” Dr. Swindells said. “They need a roof over their head and food. They’re worried about the security of themselves and their children, keeping the electricity on. Medicine-taking is down the list. It gets forgotten and left off.

“Although this is in the early stages of development, this option, where you’d come here for an injection every other month or so, would be fantastic.”

The drugs were developed by the pharmaceutical company ViiV, which wanted to work with UNMC on this project due to the medical center’s longstanding role as a leader in HIV-drug research. Howard Gendelman, M.D., chair of pharmacology and experimental neuroscience, also is studying the ViiV drugs in his lab.

Lydiatt new vice chair of NCCN thyroid guidelines panel

by Mallory Car, UNMC public relations

 

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William Lydiatt, M.D.

William Lydiatt, M.D., professor of otolaryngology-head and neck surgery in the UNMC College of Medicine, has been appointed vice chair of the National Comprehensive Cancer Network (NCCN) Thyroid Guidelines Panel.

A member of the head and neck committee since the 1990s, Dr. Lydiatt is excited to serve in a leadership position.

“This role provides an opportunity to make a real difference in the standards of care for treating thyroid cancers,” he said. “The chair and vice chair have an important role in guiding the committee, using best evidence to enhance and improve care nationally.”

NCCN, a not-for-profit alliance of 25 of the world’s leading cancer centers devoted to patient care, research and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. As one of the 13 original NCCN member institutions, Nebraska Medicine remains committed to the organization’s vision by serving as a leader in defining and advancing high-quality, high-value cancer care.

“As founding members of NCCN, our faculty members have been extensively involved in developing and updating yearly comprehensive guidelines for the diagnosis and treatment of more than 97 percent of cancers affecting patients in the United States,” said Peter F. Coccia, M.D., Ittner Professor and vice chair of pediatrics at UNMC and NCCN board and guidelines steering committee member. “Thyroid cancer accounts for 4 percent of all cancers and more than 1 percent of people will develop thyroid cancer in their lifetime. Bill’s appointment as vice chair of the thyroid guidelines panel recognizes him as a national expert in the diagnosis and management of thyroid cancer.”

“This is not only an outstanding recognition for Dr. Lydiatt and the expertise he has in thyroid cancer but also his talent in collaboration and building consensus with respected colleagues in premier cancer programs,” said Theresa Franco, cancer care service line executive director at Nebraska Medicine. “This brings prestige and value to our cancer program and advances the reputation of the Fred & Pamela Buffett Cancer Center.”

“To have this kind of influence in setting standards of care is such an honor,” said Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center. “This appointment reflects Dr. Lydiatt’s unwavering commitment to educating the world in best cancer care practices.”

Five cancer researchers recruited to Fred & Pamela Buffett Cancer Center

 

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The Fred & Pamela Buffett Cancer Center at the University of Nebraska Medical Center and its clinical partner, Nebraska Medicine, has added five new translational cancer researchers to its staff in recent months.

The Fred & Pamela Buffett Cancer Center is Nebraska’s only National Cancer Institute-designated cancer center. It is affiliated with the University of Nebraska Medical Center and its clinical partner, Nebraska Medicine. Located at 45th Street and Dewey Avenue, the Fred & Pamela Buffett Cancer Center is scheduled to open in 2017.

The recruits hail from some of the nation’s top scientific and medical institutions. Collectively, they bring more than $5 million in cancer research funding to Nebraska. All have begun their work at the Fred & Pamela Buffett Cancer Center during the past four months.

“When we launched this ambitious project to build the world’s finest cancer center right here in Omaha, we believed that it would attract the very best minds in cancer research from around the world,” said Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center.

“These recruits exemplify that vision. We are building a place where pioneering scientific exploration will shape the future of cancer science and medicine – and these recruits are just the start.”

The $323 million Fred & Pamela Buffett Cancer Center – the largest construction project ever on the medical center campus – will create approximately 1,200 jobs at the medical center alone, plus thousands of others in construction and related industries. In total, the project will provide 4,657 new jobs to the metro area, infusing $537 million annually into the economy on an ongoing basis.

As translational cancer researchers, these new recruits conduct research that applies discoveries generated in the laboratory directly to patients’ bedsides.

The new recruits are:

Nick Woods, Ph.D.
• Recruited from H. Lee Moffitt Cancer Center in Tampa, Fla. Joined the Fred & Pamela Buffett Cancer Center on Oct. 1.
• Has a $400,000 National Institutes of Health (NIH)/National Cancer Institute (NCI) grant in breast cancer.
• A Fairfield, Neb., native and cancer survivor, Dr. Woods’ primary research interest is systems biology based analysis of protein-protein interactions networks associated with cancer signaling pathways to identify novel targets for cancer therapies. His future goals are to examine acute myeloid leukemia signaling pathways associated with Fanconi Anemia proteins.
• For more information on Dr. Woods, click here.

Michael Green, Ph.D.
• Recruited from Stanford University. Joined the Fred & Pamela Buffett Cancer Center on Nov. 1.
• Has a $195,000 grant funded by The Leukemia & Lymphoma Society.
• Dr. Green works to identify and understand the genetic alterations that give rise to lymphoma and allow it to evade the immune system. He is interested in the genetics of B-cell lymphoma, with the goal of using genetic profiling to understand disease biology and inform treatment decisions.
• For more information on Dr. Green, click here.

Amar Singh, Ph.D.
• Recruited from Vanderbilt University. Joined the Fred & Pamela Buffett Cancer Center on Oct. 1.
• Has a $1.65 million National Institutes of Health grant in colon cancer.
• Brought one other Ph.D. level researcher with him to Nebraska.
• Dr. Singh’s research focuses on understanding the role of the tight junction proteins, claudins, in the regulation of barrier function, colonic inflammation and neoplastic transformation and growth in correlation with the EGF receptor signaling.
• For more information on Dr. Singh, click here.

Punita Dhawan, Ph.D.
• Recruited from Vanderbilt University. Joined the Fred & Pamela Buffett Cancer Center on Oct. 1.
• Has a $950,000 Veteran’s Affairs Health Grant in colon cancer
• Recruited one additional Ph.D. postdoctoral fellow from Chicago.
• Dr. Dhawan focuses her research on claudins, metastasis, tumorigenesis, signal transduction and trafficking, and cell death and differentiation.
• For more information on Dr. Dhawan, click here.

Rebecca Oberley-Deegan, Ph.D.
• Recruited from National Jewish Hospital in Denver. Joined the Fred & Pamela Buffett Cancer Center on Aug. 1.
• Has a $1.65 million National Institutes of Health/National Cancer Institute grant in prostate cancer
• Dr. Oberley-Deegan’s research examines the role of oxidative stress and inflammation in the context of radiation and cancer biology. Her laboratory previously has shown that a catalytically active antioxidant can protect normal prostate tissues during radiation, but not prostate tumor tissues. The focus of her research is to determine the mechanisms by which antioxidants can protect normal tissues from radiation while simultaneously making the tumor vulnerable to radiation damage.
• For more information on Dr. Oberly-Deegan, click here.

Nebraska moves into top 10 of healthiest states in U.S.

Liz Kumru

Ali_Khan_M_D_

Ali Khan, M.D.

Nebraska has moved into the top 10 among the healthiest states in the country.

In a report issued by the United Health Foundation earlier this month, Nebraska moved up one notch after ranking No. 11 last year. The five states surrounding Nebraska ranked between 18 and 36.

“We are heading in the right direction,” said Ali S. Khan, M.D., M.P.H., dean of the University of Nebraska Medical Center College of Public Health. “With a real concerted effort, we can reach No. 1 by 2020.”

Since joining UNMC in July, Dr. Khan has traveled across the state to talk about how to improve the state’s health indicators. He supports UNMC Chancellor Jeffrey P. Gold, M.D., and his strategic goal to work with all health systems and private and community partners to help make Nebraska the healthiest state in the union by 2020.

The report, “America’s Health Rankings: A Call to Action for Individuals and their Communities,” analyzed the health of the nation holistically with in-depth data and analysis. Its focus is on behaviors, community and environment, policy and clinical care to provide a comprehensive picture of the nation’s health. Indicators are: low birth weight, smoking, obesity, drug deaths, physical inactivity and adolescent immunizations.

First, the good news – Nebraska ranks:
• First – High rate of high school graduation. In the past two years, high school graduation increased 12 percent from 82.9 percent to 93 percent for incoming ninth graders. Nebraska is tied with Vermont for the highest graduation rate in the nation.
• Second – High immunization coverage among children. In the past year, immunization coverage among children increased by 9 percent from 72.6 percent to 79 percent for children aged 19 to 35 months.
• Third – Low rate of drug deaths.
• 10th – In the past year, the number of children in poverty decreased by 27 percent from 19.6 percent to 14.3 percent.
• 24th – In the past year, preventable hospitalizations decreased by 13 percent from 63.8 to 55.8 per 1,000 Medicare beneficiaries.

Still, it isn’t all good news. In areas that need work, Nebraska ranks:
• 16th – In the past two years, the percentage of adults with diabetes increased 10 percent from 8.4 percent to 9.2 percent.
• 21st – Percentage of adults who are smokers (self-report smoking at least 100 cigarettes in their lifetime and currently smoke).
• 23rd – Public health funding.
• 27th – Percentage of adults who are obese.
• 44th – Percentage of adults who self-report drinking alcoholic beverages on at least one occasion in the last month: women – four or more drinks at one sitting; men – five or more drinks at one sitting.

This marks the 25th year that UHF has issued state rankings in partnership with the American Public Health Association and Partnership for Prevention.

America’s Health Rankings is the longest-running report of its kind. It provides analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socioeconomic data to determine national health benchmarks and state rankings. The rankings employ a unique methodology that is developed and annually reviewed and overseen by a Scientific Advisory Committee of leading public health scholars.

The data in the report come from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education, and the Census Bureau.

To view the rankings in full, go to www.americashealthrankings.org.

How the states rank

Here are the top 10 states, and the last:

1 – Hawaii

2 – Vermont

3 – Massachusetts

4 – Connecticut

5 – Utah

6 – Minnesota

7 – New Hampshire

8 – Colorado

9 – North Dakota

10 – Nebraska

States surrounding Nebraska and their rank:
• South Dakota – 18
• Iowa – 24
• Wyoming – 25
• Kansas – 27
• Missouri – 36

New Catheter System Navigates and Fixes Arterial Blockage

For approximately 18 million Americans, it’s a disease that affects nearly every step. Walking down the sidewalk or up a flight of stairs causes painful cramping in the hip, thigh or calf muscles. Left untreated, it’s the leading cause of amputation in patients over 50.

Dr-David-Vogel

David Vogel, MD

“Those highest at risk for peripheral artery disease (PAD) are smokers,” said David Vogel, MD, a vascular surgeon at Nebraska Medicine. “However, diabetes is also an important risk factor, along with obesity and advanced age.”

PAD is a circulatory problem caused by the build up of plaque in the arteries of the legs. These blockages limit blood flow to the leg muscles, causing pain during activity. In the past, patients with PAD required bypass surgery, which meant several days in the hospital, followed by an extended recovery time of weeks to months.

Fortunately, new lumivascular technology is being used at Nebraska Medicine to treat patients with PAD. The Ocelot catheter system allows doctors to navigate inside long, blocked leg arteries for the first time. It’s used in combination with the Lightbox, a mobile imaging device that delivers optical coherence tomography imaging (OCT), which enables physicians to see from inside an artery during the procedure.

Ocelot-Catheter-system

Ocelot Catheter System 

“It basically works by sending out a light source – in this case, a low power, red laser,” explained Dr. Vogel. “The light then reflects off the plaque and artery, giving us an image. With that image, we can steer the catheter through the plaque to the open artery on the other side of the blockage. It’s much safer than trying to blindly push a wire and catheter across a blockage, which can lead to perforation of the artery.”

In July 2013, doctors at Nebraska Medicine – Nebraska Medical Center began using this technology. It’s the only hospital in Nebraska, Iowa, Kansas and South Dakota currently treating PAD patients with the Ocelot catheter system. The next closest providers are in Chicago, St. Louis and Columbia, Mo.

“Dr. Vogel is one of 20 people in the United States working with the latest lumivascular technology,” said Michael Moulton, MD, chief of the division of cardiothoracic surgery at Nebraska Medicine. “There’s no one else in the entire region doing this type of treatment. Patients with PAD would do extremely well seeing Dr. Vogel.”

Dozens of patients have undergone the procedure at Nebraska Medicine, including Billy Baney, who’s worked at Union Pacific Railroad for over 20 years.

Billy-BaneyBilly Baney
“I build railroad tracks, so I do a lot of walking. Up and down the tracks. I need my legs to do my job.”

In late 2013, Baney came to Dr. Vogel, looking for a second opinion, after doctors at another area hospital told him he’d need bypass surgery.

“I left there shaking. Got into my car and said, ‘I can’t believe this,’” remembered Baney. “When I found Dr. Vogel, he told me that we could avoid major surgery.”

In February 2014, Dr. Vogel used the Ocelot catheter system to navigate through Baney’s blocked arteries. By April, Baney was building train tracks again.

“Dr. Vogel is really good at what he does,” said Baney. “I can’t thank him enough for helping me get back on my feet and back to work.”

Symptoms of PAD:
•Painful cramping in the hip, thigh or calf muscles after walking or climbing stairs
•Leg numbness or weakness
•Coldness in the lower leg or foot
•Sores on the toes, feet or legs that will not heal
•Skin on your leg turns pale or bluish when leg is elevated
•Your foot turns a dusky red when you stand or sit
•The hair on your foot stops growing
•Your toenails stop growing
•You get frequent toenail infections

Preventing PAD:
•If you smoke, your risk of getting PAD increases four times
•Controlling high blood pressure, high cholesterol and diabetes will decrease your risk
•Maintaining a healthy weight and getting regular exercise will improve your overall health

To schedule an appointment with Dr. Vogel, call (800) 922-0000.

 

More Lung Cancer Awareness Could Lead to Better Patient Outcomes

Lung cancer is the main cause of cancer related death in the United States and world-wide. The proportion of patients with lung cancer surviving 5 years or greater is a dismal 15 percent. This statistic has not changed substantially in the past 30 years. One of the major causes of the dismal survival seen in lung cancer today is that most patients are diagnosed when the tumor is quite advanced. Lung cancer caught in an early stage is curable with surgery, but unfortunately only a minority of patients present at an early stage. If there was a way in which more patients were detected at an early stage, then outcomes for lung cancer patients would improve dramatically.

While this sounds simple in theory, the fact is that we currently do not have any way to detect lung cancer in the early stages. Most patients who have early stage lung cancer are identified serendipitously on a scan performed for something completely unrelated. The tests that we have today to diagnose lung cancer, chest X-rays, sputum analysis and Computerized Axial Tomography (CT) scans are fraught with problems.

Most patients who have early stage lung cancer are identified serendipitously on a scan performed for something completely unrelated.

Multiple studies both in the United States and abroad performed in the 1960’s and 1970’s have shown that screening for lung cancer with a chest X-ray and sputum studies actually resulted in an increased mortality, rather than increasing survival from lung cancer. There have been a number of advances in CT scan technology in the past few decades and there has been a renewed interest in using CT scans to screen for lung cancer. Current studies from Japan, Italy and United States appear promising, but use of CT scans to screen for lung cancer is not yet ready for primetime. Clearly we need to do more in order to improve the outcomes of patients with lung cancer.

A major reason for the lack of major advances in the lung cancer field is the minimal funding for lung cancer research. One reason for this may be the absence of long-term survivors who can raise lung cancer awareness in the society and also be passionate advocates for increased funding support, much like the breast cancer survivor. Another more worrisome reason is the apathy of professional organizations and funding agencies towards lung cancer. I was at a meeting a couple of years ago, when a speaker mentioned in a very tongue in cheek manner, “Finally the American Lung Association has acknowledged the fact that lung cancer is a disease of the lung!” Increased funding for research has led to dramatic improvements in results from breast cancer and so it stands to reason that the same will be true for lung cancer as well.

As a lung cancer doctor, I live on optimism. Recently there has been increasing activity among patient advocacy groups, such as The National Lung Cancer Partnership and the Bonnie J. Addario Lung Cancer Foundation trying to raise awareness of lung cancer. The daughter of one of my patients, living in Omaha, Neb. recently set up an organization called “Where is The Funding for lung cancer?” She likes to call it “WTF” for effect. If these and other efforts are successful, there is no reason why we should not be able to increase the number of lung cancer survivors in the near future.

New Heart Procedure Helps Mitral Regurgitation Patients

Viola-Foley

For 78-year-old Viola Foley, nothing brings a bigger smile to her face than talking about family, country music or Nebraska Medicine.

“I tell everyone that the nicest doctors in the world work here,” she says. “They saved my life more than once.”

After raising nine children in Springfield, Neb., Foley underwent a liver transplant at Nebraska Medicine – Nebraska Medical Center and battled breast cancer twice.

“I was diagnosed with breast cancer six years before my liver transplant, then again four years later. It’s amazing how far I’ve come.”

Once Foley passed the 10-year mark for her transplant, she started having serious breathing problems. Walking across the living room was almost impossible. In September, she made an appointment with Nebraska Medicine cardiologist Thomas Porter, MD.

“Dr. Porter did an echocardiogram,” remembers Foley. “He discovered that my heart and liver were working against each other. One of my heart valves wasn’t opening and shutting the right way.”

In September, Foley was diagnosed with mitral regurgitation (MR), a condition that affects four million people in the United States. The heart’s mitral valve leaflets don’t close tightly, causing blood to flow backwards from the heart’s left ventricle into the left atrium. It makes the heart work harder at pushing blood through the body, leading to shortness of breath, fatigue and worsening heart failure. For many patients, open-heart mitral valve surgery is generally recommended, but for Foley, surgery wasn’t an option.

“She currently has a life threatening blood disorder that prohibits her from having any open surgical procedures,” says Michael Moulton, MD, chief of cardiothoracic surgery at Nebraska Medicine. “Her only shot was to have the MitraClip procedure, which was recently approved by the U.S. Food and Drug Administration.”

MitraClip-Inserted

The MitraClip Clip Delivery System (MitraClip CDS) is a new option for patients diagnosed with MR, who have too high a risk for surgery. The procedure consists of implant catheters and the MitraClip device, which is a permanent implant that attaches to the mitral valve leaflets, reducing the leakiness of the valve.

On October 1, Foley became the first patient to undergo the procedure at Nebraska Medicine. With the help of a catheter, Nebraska Medicine chief of interventional cardiology, Gregory Pavlides, MD, inserted the MitraClip device through a blood vessel in Foley’s groin, guiding it to her heart. The surgical team could watch in real time on the echo machine if the mitral regurgitation was appropriately reduced. Once the MitraClip device was in place, the catheter was removed.

“This procedure requires a lot of skill from interventional cardiology, imaging cardiology and anesthesia,” explains Dr. Pavlides. “Not many places in the area have the infrastructure to offer the MitraClip procedure as well as we can; based on our experience with the mitral valve and our superb imaging and cath lab skills.”

Foley’s procedure took approximately one hour and 30 minutes. She spent a little over three days in the hospital before going home. Since then, she’s regained her strength, is able to walk up and down the stairs and feed her pets without feeling fatigued. She’s excited for the next chapter in her life, which includes watching her great-grandson attend the University of Nebraska Medical Center with the hopes of becoming a cardiologist.

“I am forever grateful,” says Foley. “I wouldn’t be here today if I didn’t have this option. I’m really proud to be the first patient at Nebraska Medicine to have the MitraClip procedure. Couldn’t have asked for a better crew or a better place.”

Nebraska Medicine anticipates performing the procedure on 2-4 patients per month. To connect with a member of the Heart Center team regarding the MitraClip, call (402) 559-8888 or visit their website.

 

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