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Weekly Tumor Conferences Give Breast Cancer Patients Attention of Many Experts

Medical personnel looking at x-ray image in hospital hallwayEach Wednesday morning, a team of about 30 experts gathers at the Avera Cancer Institute in Sioux Falls with a single-minded focus.

The members of the team are voracious researchers, and the focus of their meeting is a comprehensive review of the cases of breast cancer patients who are receiving care from the Institute’s physicians. During this meeting, sometimes called the tumor conference, experts from a wide range of cancer-fighting disciplines review imaging, biopsy results and reams of other information. They collaborate knowing no two patients have the same cancer.

“While some cases are more straightforward, this meeting can really help us to personalize the care each patient receives,” said Avera Cancer Institute Breast Cancer Patient Navigator Nancy Terveen. “But cancer care is continually evolving and our surgeons, oncologists, radiologists and others on the team can share insight, share findings and compare notes. So every patient is actually receiving the attention of a large group of cancer experts.”

Terveen said that the weekly meetings allow for the latest research to be discussed. Clinical trials that are starting are one area where physicians share information. She said this approach offers opportunities for doctors to consider a variety of approaches.

“When we can gather multiple surgeons in one room, we can look at all the options, and while the primary physician for that cancer patient will have the final say, the group can offer insights and make recommendations,” she said. “We can look at the results of certain approaches and consider the qualifications of other patients. It’s a way to personalize care and we go through the information for all new patients.”

The team evaluates all Avera Cancer Institute breast cancer patient cases at the start of care as well as a second time when treatment is completed, Terveen said.

“The biggest thing is that your doctor presents your case within a multidisciplinary discussion, where other physicians and others can augment his or her ideas for the best approach,” she said. “When more opinions are shared, research shows it leads to better results, and since every patient is different, it’s good to get more insight.”

Avera Cancer Institute has held these meetings for almost a decade, and Terveen said they continue because they help the most important person who is at the center of the entire conversation: the patient.

“Studies are published almost every day, and that information can help our physicians and their patients,” she said. “We also review every patient’s information at least twice, so that we can personalize their journey and give them every possible piece of information that can make a difference and result in the best possible outcome.”

Membership in Big-Data Cancer Program Will Help Avera Improve Care

doublehelixSometimes you have to step back to see the big picture and allow those patterns to form before your eyes. That’s the idea behind “big data” projects where trends and associations come to light when enough information is brought together.

It’s not enough to have lots of data; you have to skillfully evaluate it.

That’s exactly the role that Avera Cancer Institute will play now that it has joined CancerLinQ™, an initiative the American Society of Clinical Oncology (ASCO) has established.

In addition to Avera, more than 65 other facilities have joined the CancerLinQ™ system. Doing so should provide new resources for more cancer patients; information in the system can be studied by a range of physicians, making the pool of data deeper and potentially more effective.

Benjamin Solomon, MD, Avera Medical Group Oncology & Hematology specialist, said joining this “learning intelligence” network could help provide a wealth of information for Avera cancer physicians, as well as any doctor in the system.

“Efforts like this can provide the latest evidence to doctors in our system as well those around the nation – and the world,” he said. “It gives us the ability to make comparisons in treatment outcomes across a wide spectrum of diseases. Our participation may help improve the way cancer patients are treated tomorrow as well as for generations to come.”

Avera Cancer Institute’s geographic reach, with locations in Aberdeen, Mitchell, Pierre, Sioux Falls and Yankton, S.D., and Marshall, Minn., means the overall contribution of information Avera cancer patients make will only be more significant.

It’s done in such a way that the information shared is called “de-identified data.” Taking that step insures all patients’ privacy while bolstering the information that can help stop many types of cancer.

“CancerLinQ™ gives us, as cancer care providers, access to the analysis of literally millions of cancer patient medical records, which may give us the ability to uncover patterns and trends. We expect to apply that information to patient care here at Avera,” Solomon said. “In addition, we hope to monitor our own outcomes and weigh those against approaches used in similar cases. We can also review the steps taken and compare them to recommended guidelines.”

Solomon added that since CancerLinQ™ is the only effort of its kind being driven by the American Society of Clinical Oncology, a non-profit, physician organization. The system helps to combine the shared expertise of leading oncologists.

“The simple mission is the same: improve the care of all people living with cancer,” he said. “Avera Cancer Institute now is adding to the collective experience and knowledge of cancer care. It may allow us to provide higher-quality and more tailored care for patients, no matter where they live.”

Bowdens Seek Out the Best Care for Breast Cancer, and Find it at Avera

bowden-photo-editedDoug and Mary Bowden were no strangers to the world of cancer care.

Having fathers who both passed away due to cancer, they had generously donated funds to help finance the patient navigation program at Avera Cancer Institute.

In 2011, they were on site for the ribbon cutting and gala opening of the Prairie Center in Sioux Falls, home to the Avera Cancer Institute. Doug’s experience as a caregiver and navigator for his father led him to become an executive volunteer for Livestrong.

But that “inside knowledge” didn’t temper the shock when Mary herself was diagnosed with triple negative breast cancer. It happened after the couple had moved from their long-time home of Sioux Falls to enjoy a warmer climate and proximity to family and grandchildren in Arizona.

Just a year earlier, Mary’s mammogram had been normal. But her most recent one was flagged as abnormal and worse yet, she felt a lump under her arm.

Doug wanted the very best care for his wife. So he asked his friend, Matt Ellefson, founder and president of SURVIVEiT, a non-profit cancer care rating resource based in Sioux Falls, where the “best place on planet earth” was for breast cancer treatment. “He said Avera,” Doug said.

The couple came to Sioux Falls for testing and consultations. “After three days, we had a game plan, and I would not have had it any other way. I have a great team of doctors and caregivers working on my behalf,” Mary said. Overseeing her care is Amy Krie, MD, Avera Medical Group Medical Oncologist who specializes in breast cancer.

“Triple negative breast cancer is particularly aggressive and can be difficult to treat, because many standard treatments available today target one of the three receptors, including estrogen, progesterone and HER2. We looked immediately to genomics because this science can help us identify the best possible treatment as early in the disease process as possible. For Mary, these results provided great insight into helping us to optimize her treatment recommendation,” Krie said.

Diagnosed at stage III, Mary’s cancer had reached her lymph nodes. Her treatment plan included genomic testing with the Avera Cancer Institute Center for Precision Oncology, which finds the specific genetic mutations or tumor drivers and matches them with targeted therapies.

“We knew we had one shot at this to do it right so we moved back to Sioux Falls for the next year. We’re all in and committed to doing it the right way,” Doug said.

In Mary’s treatment plan, she would have chemotherapy first to kill as much cancer as possible, followed by surgery.

“Cancer often has not just one genomic driver, but two or three genomic drivers. For example, one may sustain the proliferation of the tumor. Another may help it build a blood supply. Another may help it to invade and metastasize,” said Brian Leyland-Jones, MB BS, PhD, Vice President of Avera’s Center for Precision Oncology. “What we do differently is that we try to hit all drivers together with combination therapy at the earliest possible opportunity.”

“Cancer continues to grow, deviate and become more resilient. It is learning more tricks as the disease progresses. Catching it early is absolutely key,” Leyland-Jones said.

Mary remembers the day her chemo began last fall. Ironically, as she browsed through the Facebook feed on her phone, she saw a memory from five years ago pop up – the day she was at the Prairie Center opening event.

When she comes for her chemo infusions, Mary says it’s not unusual to be visited by four to five Avera team members, from nurses to art therapists, patient navigators and chaplains. “They’re all great people and they all care. I couldn’t do this alone.”

Adding to the expert care team is the environment of the Prairie Center. “From the time we walk in the door, we have this sense of peace and serenity because we know we’re in the right place,” Doug said.

Mary is still progressing through her pre-surgery treatment plan. “She’s just doing incredibly well,” Doug said.

“It’s not easy to hear the words, ‘you have cancer.’ That’s very frightening,” Mary says. Yet the treatment is not taking the toll she expected. “I’m able to exercise, ride my horses, play with my grandchildren and do everything I did before. I have some slow days, but I’ve learned to listen to my body. Living with cancer is OK for me because I’m going to beat it.”

“With our targeted therapy, we modulate doses so people can live normal lives,” Leyland-Jones said.

Genomic research is taking place all over the world, yet much of this new knowledge does not yet reach the patient bedside. “Here at Avera, we are piecing together all of the published literature and applying it now. We attempt to crush the tumor at the earliest possible time frame using evidence-based genomic marker-targeted therapy matches,” Leyland-Jones said. “In the end, the only focus is each and every patient and their families.”

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