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Archive for March, 2016

Multidisciplinary Breast Cancer Clinic Provides Team Approach

Today, there are numerous choices available for breast cancer treatment and women want to be a part of that decision-making process. The Nebraska Medicine’s Multidisciplinary Breast Cancer Clinic at Village Pointe Cancer Center provides a very personalized and comprehensive approach to breast cancer care based on a patient’s individual needs and wishes as well as the expertise and careful assessment of a team of breast cancer specialists.

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Sarah Thayer, MD, PhD

“We believe that the best care plan is one that has been developed with the input and expertise of a multidisciplinary team of cancer experts,” says Sarah Thayer, MD, PhD, surgical oncologist at Nebraska Medicine and physician-in-chief at the Fred and Pamela Buffett Cancer Center. “Our multidisciplinary team of experts will help each patient navigate through the many decisions available in breast cancer treatment including lumpectomy, mastectomy, chemotherapy, radiation therapy, targeted therapies and breast reconstructive surgery in a collaborative approach.

The multidisciplinary team includes medical oncologists, surgical oncologists, radiation oncologists, plastic and reconstructive surgeons, oncology nurses, geneticists and social workers who will work closely with each patient to provide a very personalized and patient-directed care experience.

The Seventh: Extraordinary Innovations and Emerging Trends in Transplantation and Oncology

July 12 – 13, 2016

Nebraska Medicine is co-sponsoring a two day conference with OPTUM Health that highlights advances in complex cancer treatment and transplants’ organ failure management. The structure of the Nebraska Medicine’s Multidisciplinary Breast Cancer Clinic will be reviewed, in addition to, key components in managing organ failure.

For more information about this continuing education series, visit optumhealtheducation.com.

As part of the evaluation, all outside films and mammograms are re-reviewed by a specialized breast radiologist. The clinic also offers the newest, most advanced form of mammograms, called 3-D mammography. “This new technology increases detection rates by 40 percent and is able to find the cancers at a smaller size — in all levels of density of the breast,” says Cheryl Williams, MD, radiologist at the Multidisciplinary Breast Cancer Clinic. “This is very important. The smaller a tumor is when we find it, the more likely it is that we’ll be able to cure it.”

“Patients benefit from getting not just one opinion, but a comprehensive plan developed by a multitude of breast cancer experts using the most recent studies,” says Dr. Thayer. “This model allows for enhanced communication between providers and the patient to ensure her goals and individual needs are met.”

When a patient arrives for her appointment, she sees all of the specialists required for that visit in one setting and one appointment. Not only does this save the patient time, but helps eliminate duplication of tests and services. “This streamlined approach to care provides a more comfortable and pleasant experience for the patient,” says Dr. Thayer.

Cheryl-WilliamsCheryl Williams, MD

The Village Pointe Cancer Center is located at 175th and Burke St. just west of the Village Pointe shopping center. The Multidisciplinary Breast Cancer Clinic offers easy access with care provided in an intimate and comfortable environment. Patients can receive an array of cancer services in one convenient location:
•Comprehensive care plan developed by a multidisciplinary team of experts
•Consultative services or second options from cancer experts in medical oncology, surgical oncology, radiation oncology and plastic and reconstructive surgery
•Infusion services within private infusion rooms
•Radiation treatment center
•Women’s Imaging Center with state of the art 3D-mammography and MRI capabilities
•Amenities and supportive services including wig fittings, a free wig bank, prosthetic and bra fittings, yoga, massage therapy, skin care and make-up lessons specifically geared for people with or recovering from cancer

“Addressing a patient’s physical, educational, emotional and spiritual needs are important aspects of providing a more complete and holistic approach to care,” notes Dr. Thayer.

Patients will also be given the opportunity to participate in breast cancer clinical trials offered through the University of Nebraska Medical Center as part of their treatment program.

“The Multidisciplinary Breast Cancer Clinic is designed to provide patients the most oncologically-sound plan in an environment that is more personal, private and positive,” says Dr. Thayer.

To speak to a member of our multidisciplinary breast cancer team or to make a referral, please call 402-559-1600.

Virtual Incision mini-robots conduct first known human surgery

by Virtual Incision

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Dmitry Oleynikov, M.D., a UNMC professor of surgery, operates a surgical robot as in the background Shane Farritor, Ph.D., a UNL engineering professor, adjusts the camera on the surgical subject in this 2015 photo illustration. The two developed the robot for minimally invasive surgeries. Their startup company, Virtual Incision, announced March 1 the first use of its miniaturized robot in human surgery.

Virtual Incision Corp., a company founded by faculty members at the University of Nebraska-Lincoln and UNMC, has announced the successful first-in-human use of its miniaturized robotically assisted surgical device.

The device is designed for general surgery abdominal procedures, with an initial focus on colon resection, a procedure performed to treat patients with lower gastrointestinal diseases including diverticulitis, colon polyps that are too large to be removed endoscopically, pre-cancerous and cancerous lesions of the colon and inflammatory bowel disease.

“To the best of our knowledge, this is the first time an active miniaturized robot has performed complex surgical tasks with the robot inside a living human, which is a significant milestone in robotics and in surgery,” said Shane Farritor, Ph.D., a UNL professor of mechanical engineering who is Virtual Incision’s co-founder and chief technical officer.

The robotically assisted colon resection procedures were completed in Asunción, Paraguay, as part of the safety and feasibility trial for the technology. The surgeries were successful and the patients are recovering well, according to a news release from the company.

“Virtual Incision’s robotically assisted surgical device achieved proof-of-concept in highly complex abdominal procedures,” said head surgeon Dmitry Oleynikov, M.D., chief of minimally invasive surgery at UNMC and co-founder of Virtual Incision.

“Additionally, we verified that our extensive regimen of bench, animal, cadaver, biocompatibility, sterilization, electrical safety, software, human factors and other testing enabled the safe use of this innovative technology.”

Unlike today’s large, mainframe-like robots that reach into the body from outside the patient, Virtual Incision’s robot platform features a small, self-contained surgical device that is inserted through a single midline umbilical incision in the patient’s abdomen. Virtual Incision’s technology is designed to utilize existing tools and techniques familiar to surgeons, and does not require a dedicated operating room or specialized infrastructure.

Because of its much smaller size, the robot is expected to be significantly less expensive than existing robotic alternatives for laparoscopic surgery, Dr. Oleynikov said. Virtual Incision’s technology promises to enable a minimally invasive approach to surgeries performed today with a large open incision, he said.

The robotically assisted surgical device is an investigational device and is not commercially available. John Murphy, Virtual Incision’s CEO, said robotically assisted surgical devices are beneficial, but existing surgical robots have limitations that prevent pervasive use during certain surgeries, such as colon resection. The firm will build upon the positive completion of the feasibility study, as it works toward clearance for the system in the United States.

Honing in on new drug treatments for lung cancer

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APAR KISHOR GANTI, MD

Lung cancer has long been a mystery – as we didn’t know much, until the past decade, about the vast number of what we call “non-small cell lung cancers.”

More recently, one discovery after another has revealed the secrets. We now can identify certain categories of these tumors. We know that a large number — 40% — are a type called adenocarcinomas. Pemetrexed is a chemotherapy drug that seems to benefit patients with lung adenocarcinomas. Upwards of 30 percent of patients have a good response to it.

Within the group of adenocarcinomas, we have also identified many sub-types, the most common being K-RAS, EGFR and ALK.

We now have a very exciting tool called molecular tumor testing, which allows us to test a patient’s tumor to determine which type it is, and determine treatment based on that type.

This has revolutionized lung cancer treatment for some patients. But it hasn’t solved all our treatment problems. Let’s look at the three sub-types of lung cancer, and the drugs.

EGFR: EGFR (epidermal growth factor receptor) tumors. Patients with these tumors have had success with a drug named Iressa, introduced in the early 2000s. In one study, this drug eradicated the tumors within weeks – nearly a miracle!

Unfortunately back then, we did not know what caused this drug to work miracles in some patients, but not others. But research showed that patients who responded to these drugs had a mutation in the EGFR gene — and there are two drugs approved in the US for these patients; erlotinib and afatinib. Almost 55-60% of patients with these mutations will respond to these drugs, rates that are unheard of with conventional chemotherapy.

ALK: ALK, or anaplastic lymphoma kinase is a gene, which when activated, seems to promote the growth of lung cancers. Two drugs are used to treat this particular mutation: Crizotinib and Ceritinib. Up to 60 percent of patients have consistently responded to these drugs – almost double the response to conventional chemotherapy.

K-RAS: Former and current smokers with lung cancer tend to have the K-RAS sub-type, which is caused by a gene mutation. We are still working to understand this mutation. To date, we don’t have specifically targeted treatments for this subtype, but researchers are hard at work on this.

As you see, this growing body of knowledge has helped many patients. But we still have unanswered questions for many others—specifically, people who smoke.  Nevertheless, these advances give much more optimism.

I do not believe that we should accept that three quarters of patients will not respond to chemotherapy and do nothing about it. I always encourage those patients to enroll in a clinical trial. Why would you not, when a new treatment approach might give you a better chance? You’ll possibly help extend your own life – and you will certainly help advance our medical understanding of this disease.

At Nebraska Medicine, our service is designated by the National Cancer Center as a Lung Cancer Alliance Screening Center of Excellence. This reflects our team’s experience as well as our multidisciplinary program in managing patient care.

With this level of expertise, you will receive the treatment that specifically targets your lung cancer sub-type. We’ll stay with you every step of the way, making sure you’re getting excellent care.

Nebraska Medicine/UNMC, Nebraska DHHS Selected As Special Pathogen Treatment Center

The U.S. Department of Health and Human Services has selected nine health departments and associated partner hospitals to create a new network to respond to outbreaks of severe, highly infections diseases. The Nebraska Department of Health and Human services in partnership with Nebraska Medicine – Nebraska Medical Center is one of the nine facilities on the list.

Nearly $30 million of federal funding will be coming from HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) to enhance the regional treatment centers’ capabilities to care for patients with Ebola or other similar illnesses. “This approach recognizes that being ready to treat severe, highly infectious diseases, including Ebola, is vital to our nation’s health security,” said Dr. Nicole Lurie, HHS assistant secretary for preparedness and response. “This added regional capability increases our domestic preparedness posture to protect the public’s health.”

“We are very grateful for the trust being shown to us by HHS in naming Nebraska Medicine as one of these regional centers,” said Jeffrey P. Gold, M.D., chancellor of the University of Nebraska Medical Center and chairman of the Nebraska Medicine Advisory Board. “Our track record in caring for Ebola patients is certainly a contributor toward achieving this goal, but this is also a credit to the countless individuals at Nebraska Medicine and UNMC who have continued to work tirelessly to ensure we continue to be at the forefront of the nation’s and world’s fight against the deadliest of diseases.”

Dr. Gold also said Nebraska Medicine and UNMC’s continuing effort in training hundreds of other medical experts from around the country and around the world in the best practices for handling patients with highly infectious diseases played a role in the selection.

“Our agency has partnered with Nebraska Medicine – Nebraska Medical Center for more than 10 years. They have the facility and the expertise to provide specialized care to people with highly infectious diseases like Ebola,” said Jenifer Roberts-Johnson, deputy director of the Division of Public Health for the Nebraska Department of Health and Human Services. “We’re pleased to continue our work together to further increase our level of preparedness and help protect the health of our citizens.”

Each awardee will receive approximately $3.25 million over the full five-year project period. This funding is part of $339.5 million in emergency funding Congress appropriated to enhance state and local public health and health care system preparedness following cases of Ebola in the United States stemming from the 2014 Ebola epidemic in West Africa.

The facilities announced today will be continuously ready and available to care for a patient with Ebola or another severe, highly infectious disease, whether the patient is medically evacuated from overseas or is diagnosed within the United States.

The nine awardees and their partner hospitals are:
•Massachusetts Department of Public Health in partnership with Massachusetts General Hospital in Boston, Massachusetts
•New York City Department of Health and Mental Hygiene in partnership with New York City Health and Hospitals Corporation/HHC Bellevue Hospital Center in New York City
•Maryland Department of Health and Mental Hygiene in partnership with Johns Hopkins Hospital in Baltimore, Maryland
•Georgia Department of Public Health in partnership with Emory University Hospital and Children’s Healthcare of Atlanta/Egleston Children’s Hospital in Atlanta, Georgia
•Minnesota Department of Health in partnership with the University of Minnesota Medical Center in Minneapolis, Minnesota
•Texas Department of State Health Services in partnership with the University of Texas Medical Branch at Galveston in Galveston, Texas
•Nebraska Department of Health and Human Services in partnership with Nebraska Medicine – Nebraska Medical Center in Omaha, Nebraska
•Colorado Department of Public Health and Environment in partnership with Denver Health Medical Center in Denver, Colorado
•Washington State Department of Health in partnership with Providence Sacred Heart Medical Center and Children’s Hospital in Spokane, Washington

The regional facilities are part of a national network of 55 Ebola treatment centers, but will have enhanced capabilities to treat a patient with confirmed Ebola or other highly infectious disease. Even with the establishment of the nine regional facilities, the other 46 Ebola treatment centers and their associated health departments will remain ready and may be called upon to handle one or more simultaneous clusters of patients.

The facilities selected to serve as regional Ebola treatment centers will be required to:
•Accept patients within eight hours of being notified,
•Have the capacity to treat at least two Ebola patients at the same time,
•Have respiratory infectious disease isolation capacity or negative pressure rooms for at least 10 patients,
•Conduct quarterly trainings and exercises,
•Receive an annual readiness assessment from the soon-to-be-established National Ebola Training and Education Center, composed of experts from health care facilities that have safely and successfully cared for patients with Ebola in the U.S., and funded by ASPR and the Centers for Disease Control and Prevention, to ensure clinical staff is adequately prepared and trained to safely treat patients with Ebola and other infectious diseases,
•Be able to treat pediatric patients with Ebola or other infectious diseases or partner with a neighboring facility to do so, and,
•Be able to safely handle Ebola-contaminated or other highly contaminated infectious waste.

Proposals from these facilities were reviewed by a panel of experts from professional associations, academia, and federal agencies and were selected based upon extensive criteria published in the funding opportunity announcement released in February.

To be eligible for consideration as an Ebola and other special pathogen treatment center, facilities also had to be assessed by a Rapid Ebola Preparedness team led by the CDC prior to Feb. 20, 2015.

The Department is working with state health officials and hospital executives in HHS Region IX, which includes Arizona, California, Hawaii, Nevada and the Pacific island territories and freely associated states, to identify a partner hospital awardee.

HHS is the principal federal department for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. ASPR leads HHS in preparing the nation to respond to and recover from adverse health effects of emergencies, supporting communities’ ability to withstand adversity, strengthening health and response systems, and enhancing national health security.

To learn more about the department’s efforts to protect against Ebola, visit www.cdc.gov/Ebola and for more information on the Department’s emergency preparedness and response efforts for all hazards see www.phe.gov.

Cancer center to urge increased vaccination for HPV

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Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center

In response to low national vaccination rates for the human papillomavirus (HPV), the Fred & Pamela Buffett Cancer Center has joined 68 other top cancer centers in issuing a statement urging for increased HPV vaccination for the prevention of cancer.

The institutions collectively recognize insufficient vaccination as a public health threat and call upon the nations’ physicians, parents and young adults to take advantage of this rare opportunity to prevent many types of cancer.

National Cancer Institute (NCI)-designated cancer centers joined in the effort in the spirit of President Barack Obama’s State of the Union call for a national “moonshot” to cure cancer, a collaborative effort led by Vice President Joe Biden.

“Here in Nebraska, there are about 60 new cases of cervical cancer diagnosed every year,” said Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center. “When you take into consideration that cervical cancer is preventable, it is crucial that we strongly encourage people to discuss the HPV vaccine and other screening tests, such as Pap smears, with their healthcare providers.”

Sonja Kinney, M.D., director of the division of general obstetrics and gynecology at UNMC, who sees patients at Nebraska Medicine, said the HPV vaccine is considered the standard of care for girls and boys between the ages of 9 to 26 years old.

“The main goal of this vaccine is to fight against the two high-risk HPV strains that are responsible for causing 70 percent of all cervical cancers and two low-risk HPV strains that cause 90 percent of genital warts,” Dr. Kinney said. “The vaccines are given as a series of injections that prompt the body’s immune system to make antibodies. These vaccines also provide protection against head and neck cancers and some anal cancer that may be linked to infection with the HPV virus.”

According to the Centers for Disease Control and Prevention (CDC), HPV infections are responsible for approximately 27,000 new cancer diagnoses each year in the U.S. Several vaccines are available that can prevent the majority of cervical, anal, oropharyngeal (middle throat) and other genital cancers.

Vaccination rates remain low across the U.S., with under 40 percent of girls and just over 21 percent of boys receiving the recommended three doses. Research shows there are a number of barriers to overcome to improve vaccination rates, including a lack of strong recommendations from physicians and parents not understanding that this vaccine protects against several types of cancer.

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