An Interview with Orthopaedic Oncologist Dr. Vincent Ng

Dr. Vincent Ng is an orthopaedic oncologist with the University of Maryland Greenebaum Comprehensive Cancer Center and an Assistant Professor or Orthopaedics with the University of Maryland School of Medicine.  Dr. Ng specializes in treating bone cancer and soft tissue sarcoma.  Below he answers common questions about orthopaedic oncology.

What is an orthopaedic oncologist? How do they differ from surgical oncologists?

“An orthopaedic oncologist specializes in bone and soft tissue tumors.  I treat any adult or pediatric patient with any bone or soft tissue tumor/lesion/mass, whether benign or malignant, whether it is originating from the bone or soft tissue itself or spread from another part of the body, regardless of how large or small, in the upper or lower extremities, pelvis or shoulder region.  I am often the first provider patients see when they find a concerning lump.  I can help direct their care in terms of imaging, biopsy, and referral to other providers like medical oncology and radiation oncology.

Surgical oncologists are general surgeons who tend to specialize in tumors of the organs within your abdominal cavity (pancreas, liver, colon, etc).”

What are cartilage tumors? Are they treatable?

“There is a definite spectrum of cartilage tumors and they can present in a variety of fashions.  We are seeing many patients with a variety of cartilage tumors.  Many are very small and benign, while some can be large and life-threatening.  Cartilage tumors can be challenging in diagnosis and treatment.

While tissue sample analysis can identify a lesion as a cartilage tumor and can separate the most aggressive tumors from the least aggressive ones, it is difficult to necessarily predict the future behavior based on this alone.  A comparison of the relationship between the tumor and normal bone on imaging can often be more helpful.  Whether the patient has pain is often helpful information as well.

Making careful treatment decisions for cartilage tumors (chondrosarcoma) can require a very subtle approach and it is important to have a team of radiologists, pathologists and surgeons that deal with a lot of cartilage tumors.  Sometimes cartilage tumors may be simply observed over time to make sure they remain stable while some may require very large and complex surgery to safely remove them.”

How can surgery help treat tumors in the pelvis?

“Surgical management of tumors affecting the pelvic bones is one of the most challenging areas of orthopaedic oncology.  Because of the complex anatomy associated with this region of the body, successfully removing malignant tumors from the pelvis requires a surgeon with extensive knowledge of the critical structures and how they work together.

It requires a large team to do these operations, from anesthesia and interventional radiology to the ICU and physical therapists, dozens of dedicated healthcare providers are essential to the success of the patient.

Personally, I enjoy these surgeries and have been blessed to have trained at two cancer centers with a high volume of pelvic operations and excellent surgeon mentors.  By the nature of University of Maryland being a tertiary referral center, we see many patients with pelvic tumors, some of which can be managed with radiation for which we have the new Maryland Proton Treatment Center, and some of which benefit from surgery.  The road to recovery for these patients can be long, but with rehab and a positive attitude, they often do well.  As a surgeon, seeing them succeed is one of the most rewarding parts of this profession.”

What are some misconceptions about soft tissue sarcoma?

“Soft tissue sarcoma is a life-threatening condition and I believe strongly that it needs to be addressed swiftly and aggressively.  Part of our job is educating non-oncologic physicians that any soft tissue mass could potentially be a soft tissue sarcoma and should be evaluated to avoid missing, and therefore delaying treatment for, a soft tissue sarcoma.

When the soft tissue sarcoma is localized (only in one location, the original location) and has not spread to other parts of the body, it is curable in many instances.  Treating it with radiation and surgery before it has a chance to send microscopic cells to other parts of the body is important.  It is hard to predict when a tumor will release these cells elsewhere and they sometimes do not appear until many months or even years later.  We currently do not have an effective treatment for these cells once they have spread and established themselves elsewhere in the body.  This is one of the areas that we are examining in a clinical immunotherapy trial, NEXIS, which I have designed.  If it is successful, it has the potential to help many soft tissue sarcoma patients.”

Explain the challenges of treating Ewing sarcoma.

“Ewing sarcoma often presents in a delayed fashion and can be missed by non-oncologic practitioners.  It affects children and teenagers and is truly a life-threatening condition.  Luckily, we have strong chemotherapy regimens that can usually cure the disease, particularly in younger patients.  Successfully treating Ewing sarcoma is a very long process with many weeks of chemotherapy.  Because it can occur in any part of the body, but oftentimes in the pelvis or major bones of the limbs, surgery to remove the tumor can be quite extensive and the recovery from skeletal reconstruction can be prolonged.  Nevertheless, the most important thing is removing the cancer.  I am a strong believer in wide surgical margins and radiation when possible to eliminate the primary tumor and make sure it does not return.  The success rate of treating recurrent disease is suboptimal. You really only get one good chance to cure Ewing sarcoma.”

What’s new in the world of metastatic bone cancer?

“Patients are living longer and more productive lives even when diagnosed with metastatic and incurable disease.  When cancer spreads from one part of the body to the bone, our job as orthopaedic oncologists is to minimize its impact on patients’ lives.  While we cannot cure them of their original cancer, we can stabilize the bones with surgery to significantly reduce pain and prevent fractures where the cancer has eroded through the structural integrity of the bone.  Some types of metastases such as those from thyroid or kidney cancer may be better treated with a complete resection of the cancer rather than a palliative procedure.”

How is research playing a part in improving treatment options for bone and soft tissue cancer?

“Moving the needle forward, particularly in cancer research, requires a team approach.  Each person brings their own set of experiences, perspectives, and ideas to the table.  An effective leader must have a creative vision, an untiring spirit, and the ability to think outside the box in order to solve a variety of challenges.  Here at University of Maryland, we hope to parlay the success of immunotherapy in other areas of oncology to soft tissue sarcoma in the NEXIS trial.  It is the first neoadjuvant checkpoint inhibitor immunotherapy trial that adds the potential benefit of combination immunotherapy to the existing standard of care for soft tissue sarcoma.  On a preclinical level, we are looking for potential treatments in the future with retinoic acid and chondrosarcoma, and new targeted therapy combinations for osteosarcoma.  The opportunity for me to collaborate as a clinician with these scientists is one of the advantages of working at a large University with many PhD’s and award-winning researchers.”

To learn more about UMGCCC’s Bone Cancer and Soft Tissue Sarcoma Service, please click here, or call 410-448-6400.

Going Above and Beyond to Ease the Stress of Blood & Marrow Transplant Patients

The facility where the stem cells are stored.

The Blood and Marrow Transplant unit at the University of Maryland Medical Center was presented with a challenge in housing recovering cancer patients at the beginning of March 2017. Usually, UMMC and the BMT unit use The American Cancer Society’s Hope Lodge to provide temporary housing for out-of-town BMT patients recovering from stem cell transplants. However, building construction began across the street from the Hope Lodge, making it unsafe for recovering BMT patients to stay there. Recovering from a stem cell transplant can be physically challenging, and construction debris and dirt could compromise patients’ recuperating immune systems, impeding the healing process.

This left Majbritt Jensen, a social worker at UMMC who oversees the psycho-social aspects of BMT treatment and recovery, concerned for her recovering cancer patients. Out-of-town patients must stay within an hour of UMMC to ensure that their recovery from their stem cell transplant was successful. Without discounted housing from the Hope Lodge, these patients would need to stay at a local hotel for at least 100 days. Not all insurance policies cover lodging expenses, meaning that many patients and their caretakers would be financially responsible. Jensen and her team knew that adding a financial burden to the patients and their families during this time could complicate and stress their recovery. So Jensen, along with Bob Mitchell, Associate Director for Administration, and Stan Whitbey, Vice President of Cancer Services, searched for a solution.

The solution they found was a generous grant from the Meizlesh Memorial Fund. This grant ensures that BMT patients can be housed at hotels in close proximity to UMMC. This will make it easier for the patients to be monitored during their recovery and visit the hospital if they experience any complications. Jensen attributes the success of receiving the grant money to the hard-working team surrounding her and the patients who inspire her.

“Everyone in our unit values life and treats everyone so kindly,” says Jensen. “And, I love being there for the patients and seeing them get well. Every day I am reminded of what really matters.”

Jensen also runs a support group that aims to connect current BMT patients with those who are in recovery.

For more information, visit the Bone and Marrow Transplant Service at UMGCCC.

Answering Your Colon Cancer Questions with Dr. Jiang

A new study released by the National Cancer Institute shows colon and rectal cancers have increased dramatically and steadily in young and middle-age adults in the United States over the past four decades. Dr. Yixing Jiang, a Medical Oncologist at the University of Maryland Greenebaum Comprehensive Cancer Center, answers all the questions you’re now asking yourself about colon cancer.

Q. What are the risk factors for colon cancer?

A. The risks for developing colon cancer are: obesity; insulin resistance diabetes, red and processed meat; tobacco; alcohol; family history of colorectal cancer; certain hereditary syndromes (such as familial adenomatous polyposis (FAP)); certain genetic mutations (APC mutation); inflammatory bowel disease (ulcerative colitis or Crohn’s disease); being a patient long-term immune suppression (transplant patients) and a history of abdominal radiation.

Q. Who had always been traditionally has always been at risk for colon cancer?

A. Most colorectal cancer happens sporadically. But patients with familial syndromes (FAP or Lynch syndrome), inflammatory bowel disease, certain genetic mutations, a family history of colon cancer or a history of polyos are at higher risk of developing colon cancer.

Q. What’s the best way to protect myself against colon cancer?

A. To reduce the risk of colon cancer, exercise regularly; eat less red meat, eand eat a diet high in fresh vegetables, fruits, fibers, vitamin D, and omega 3 fatty acids.  Asprin and NSAIDs been shown a degree of protection against colon cancer. Of course, the best way of preventing colon cancer is screening with a colonoscopy.

Q. What’s the best screening tool for colon cancer?

A. The screening guidelines varies depending on the recommending agencies. For example, the Center for Disease Control recommends the following: For average general population, the recommendation is to start screening colonoscopy every 10 years at age of 50; fecal occult blood test annually and flex sigmoidoscopy every 3 years. The US Preventive Services Task Force recommends screening between the ages of 50 and 75.

The most used screening test for colon cancer is a colonoscopy.

Q. Is colon cancer treatable? What’s the best treatment options?

A. Colon cancer is a very treatable disease if discovered early. For stage I cancer, surgery cures more than 90% of patients. For patients with a more advanced stage cancer, surgery alone is usually not enough. Additional chemotherapy is generally required to increase the chance of a cure. Today, with more therapies available and better surgical techniques, we are able to cure close to 30% patients with stage IV disease.

For more information on diagnosing and treating colon cancer, please visit UMGCCC’s website, umgccc.org. 

What To Ask Your Doctor (and Why) When You’ve Been Diagnosed With Lung Cancer

Heather Mannuel, MD, MBA is an Assistant Professor of Medicine at the University of Maryland School of Medicine and a Medical Oncologist at the University of Maryland Greenebaum Comprehensive Cancer Center.  Below are a few questions she says to ask your doctor when you’ve been diagnosed with lung cancer, and why they’re important to ask.

What kind of lung cancer is this? Lung cancers are divided into small cell and non-small cell types, and the treatment is very different for each of these.

What is my stage? The stage helps to give information on whether the cancer is only in the lung or whether it has spread outside the lung to the lymph nodes or to other parts of the body.  This is very important in guiding the next steps of treatment.

What kind of treatment is available for my kind of cancer?  Should I see a surgeon?  Should I see a radiation oncologist? Depending on what type of cancer you have and what stage your cancer is, you may benefit from surgery or radiation.  Some patients only receive one type of treatment, and others receive several types in sequence.  Your oncologist can discuss the options in detail with you.

What kind of chemotherapy treats this lung cancer?  Chemotherapy is sometimes given with radiation, or it may be given alone.  Often two or more different chemotherapy drugs are combined together to treat lung cancer most effectively.

What kind of side effects does the chemotherapy cause?  Although chemotherapy can cause many symptoms including nausea, diarrhea and appetite loss, there are excellent medications available today to help combat these side effects and help patients feel as well as possible during their treatment.

Is immunotherapy an option for my cancer?  Immunotherapy helps your own immune system target and fight the cancer; it is being used in a variety of different cancers today, including lung cancers, with good results.  Your oncologist can discuss whether you are eligible for this kind of therapy, when and how it fits in with standard chemotherapy, and the potential side effects.

I’m interested in adding alternative therapies to my chemotherapy; is this possible?  Many patients feel that therapies such as acupuncture and massage allow them to be more relaxed and comfortable during their treatment.  Some vitamins and herbal supplements are safe to combine with chemotherapy, but some may cause dangerous side-effects.  Before you start any type of alternative therapy, always talk with your oncologist to make sure it’s safe.

Are there any clinical trials that apply to my case?  Trials may provide an opportunity for you to be treated with drugs or other therapies that are not yet on the market but that may ultimately become standard cancer treatments in the future.  Most large cancer centers participate in clinical trials or have an association with other hospitals and centers that run trials.  You can also access https://clinicaltrials.gov/ which is run by the National Institutes of Health and which is a registry of available clinical trials across the United States for a variety of different diseases.

How will I feel during treatment?  Can I still work and take care of my children?  Although many side effects are able to be controlled today, some patients will have treatments that require them to be away from work for several weeks at a time, or that leave them fatigued and unable to maintain their normal work and child care schedule.  Your oncology team can work with a social worker or case manager to help you find solutions to these problems.

What kind of results do you expect from this treatment?  Is this curable?  This is a difficult and scary question, but it is very important to discuss this so you can plan ahead for you and your family.  Although not always the case, even incurable cancers can sometimes be treated and controlled successfully for several years.

Learn more about the Lung Cancer Service at UMGCCC by clicking here.

Kathy’s Story: Living Better with Mesothelioma – Possible with the Right Team of Experts

Kathy Ebright was enjoying life with her husband, 2 kids and 7 grandchildren in rural Pennsylvania, when everything changed suddenly.  This is true for thousands of people fighting cancer across the world, but hearing the word “mesothelioma” is not common.

“I went numb, I might have said a few words, but I couldn’t put words together to speak,” Kathy said.

Kathy and her husband, Doug

Almost everyone has been touched by cancer, but Kathy and her husband didn’t know anyone with mesothelioma in their small town of Richfield. They only heard of the disease from commercials for lawyers who specialize in asbestos lawsuits.

Kathy’s mesothelioma was discovered during a scan of her abdomen, which she has regularly to monitor a heart condition.  Her vascular doctor saw unusual spots on her scans, which her primary care doctor and oncologist reviewed, and they determined it was pleural mesothelioma.  This means the cancerous cells are located in the chest cavity, and sometimes the lung.  Usually, those with pleural mesothelioma experience shortness of breath, but Kathy was lucky enough to catch her mesothelioma before experiencing any symptoms.

Kathy’s daughter, Ally, who works with the tumor registry at the Geisinger Medical Center, sprang into action after the initial shock.  They attended tumor boards at Geisinger, where physicians from multiple disciplines (radiation, medical, and surgical oncology) meet to discuss cases.  Kathy’s medical oncologist, Dr. Rajiv Panikkar, suggested to Kathy that she go to the University of Maryland Greenebaum Comprehensive Cancer Center in Baltimore, where she would see a team skilled and experienced in the most novel treatments for mesothelioma.

On December 20, 2015, about a month after her initial diagnosis, Kathy had her first appointment with Dr. Joseph Friedberg, a nationally known expert in mesothelioma and head of thoracic surgery at the University of Maryland Medical Center.

Kathy and her family were nervous, but mesothelioma nurse navigator Colleen Norton helped them navigate the unfamiliar and frightening process of a mesothelioma diagnosis.  She made sure they were prepared for their appointment beforehand, and Colleen even handled authorization with their health insurance company.

“We just felt we were along for the ride because Colleen always had everything taken care of,” said Kathy’s husband Doug.

And they were just as impressed with Dr. Friedberg, who was calm, reassuring and explained Kathy’s situation very clearly.

“On the back of his folder, he hand drew a lung to display what was going on with me, and it could’ve been taken right from a textbook it was so good,” Kathy said.

Kathy’s granddaughter, Carleigh, who serves as her main cancer-fighting motivator

They were also impressed with Dr. Friedberg’s tenacity and understanding.  Kathy wanted to spend Christmas with her family, but Dr. Friedberg didn’t want wait too long to perform the lung sparing surgery.

Her surgery was scheduled for January 5, 2016.

Throughout the surgery, Kathy’s family couldn’t have been more comfortable and informed.

“We camped out in the Healing Garden just about the entire time,” Doug said. “Melissa Culligan, Dr. Friedberg’s nurse, was in and out of the operating room, updating us every two hours.  We were never left wondering how Kathy was doing.  We also had the option to call into the operating room if we had any questions.”

During Kathy’s recovery in the hospital, she said the nurses were “phenomenal.”  Colleen also came to see her several times a day, and they added a La-Z-Boy to Kathy’s room so her husband could more comfortably spend the nights with her.

While there is no cure for mesothelioma, yet, Kathy and her family couldn’t be happier to have the UMGCCC team in their corner.  She now returns every 3 months for the next 2 years for check-ups, and Dr. Friedberg describes her scans as “pristine.”

“It’s very reassuring to know we have such caring people looking out for my health,” Kathy said.

Learn more about the Mesothelioma and Thoracic Oncology Treatment Center at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Center by clicking here, or calling 410-328-6366.

UMMC Hosts Paintfest America

By Kirsten Bannan, System Communications Intern

For patients diagnosed with cancer, treatment may mean having surgery, chemotherapy and radiation, or a combination of all three. But, cancer patients at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) recently were treated to another type of therapy — one that indulged their inner artist and helped them step away from their illness for a moment.

The UMGCCC hosted a PaintFest America event July 7, and dozens of patients, staff members and family members spent the morning painting colorful canvas murals set up on tables in two locations in the cancer center. Several patients who weren’t able to join in the group activity even had the opportunity to paint in their hospital rooms.

The Foundation for Hospital Art is bringing PaintFest to cancer centers in every state as part of a 50day national tour that will end in New York City August 23. The nonprofit organization’s goal is to bring together families, patients and staff at cancer facilities in each state though art. “Paintfest America was nothing short of fabulous,” says Madison Friz, a 16-year-old leukemia patient who took part in the UMGCCC event after a week-long hospital stay. “As a cancer patient, it feels really good to know there are people out there in this world who care about you. To leave my hospital room to paint a picture and forget my sickness is a feeling I can’t even describe.”

UMGCCC was the only stop in Maryland on the tour, and Madison was chosen to help paint the state’s panel featuring a Baltimore oriole and a black-eyed Susan. All of the state panels will be assembled into a 10- by-15-foot mural on the final day of the tour and then returned to the hospitals where they were painted.

One of the volunteers, Morgan Feight, whose grandfather John Feight started the Foundation for Hospital Art, says that artwork provides a welcome distraction to patients and family members once the art is mounted on the walls.”

“Oftentimes, patients view hospitals as drab, starkly sterile buildings. By hanging vibrant murals throughout the hallways, we hope to change patients’ perspective and give them a sense of rejuvenating joy and hope as they stare at the designs,” she says.

Peggy Torr, a UMGCC nurse for more than 30 years, says patients were excited to take up paintbrushes and paint to participate in this event. “They were a part of something much bigger for the moment – an opportunity to calm the spirit and fuel the soul. It was palpable!”

She adds, “As healthcare professionals, we can be so task-oriented that having the opportunity to do something for our patients, instead of to them, was just amazing.”

Living with Mesothelioma: A New Normal

In December of 2007, Timonium resident Jen Blair was pregnant with her second son, Kevin. It was a “very painful pregnancy.” She went to a few doctors, who told her the pain was normal. The pain returned, “worse than ever,” six weeks after giving birth to Kevin.  More doctors. More tests. She was first told she needed laparoscopic surgery, then that she had stage 4 cancer in her abdomen. She was told to get her affairs in order.

It turns out Jen had peritoneal (in the abdomen) mesothelioma, in which cancer cells are found in the membranes around organs in the abdomen. This is very rare — only about 350-500 cases are diagnosed annually in the US – and the five-year survival rate is just 16 percent.

“It was overwhelming,” Blair said.

Now that she knew what she was up against, it was time to find a doctor.
Her brother did an Internet search of the best Mesothelioma doctors, and up popped H. Richard Alexander, MD, an internationally recognized surgical oncologist and clinical researcher at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC). UMGCCC is only a half hour from her house, but Blair said her choice had much more to do than travel time from home.

“Dr. Alexander’s team was incredibly supportive,” Blair said. “When I called with literally dozens of questions, some of which, thinking back now, were ridiculous, they always took time to give me an answer. That really impressed me.”
Just a week after calling UMGCCC about her condition, Blair met with Dr. Alexander.  After an examination, Dr. Alexander told Blair that she was a candidate for surgery. For surgery to be an option in  treating mesothelioma, it has to be considered a safe operation, and the disease has to be confined to one area. Blair decided to have surgery.

“That one decision changes everything for a patient,” Blair said.  “Not all doctors specializing in mesothelioma have the patient’s best interest at heart.”

Many doctors, Blair said, are motivated by money.  She said she’s heard horror stories from other mesothelioma patients, where doctors demanded an upfront sum of money—sometimes adding up to hundreds of thousands of dollars—before operating.  But not at UMGCCC.

In March 2008, Dr. Alexander performed surgery with HIPEC (hyperthermic intraperitoneal chemotherapy), which uses heated chemotherapy in combination with surgery to treat cancers that have spread to the abdomen lining.  While surgery to treat mesothelioma isn’t a cure, Jen’s quality and quantity of life have been greatly improved.

Blair was virtually pain free for more than seven years after the surgery, and was able to spend time with her family, and watch her two sons, Kevin and Nick, as they grew up. She had a second surgery with HIPEC in March 2015, and more than a year later, suffers very few episodes of pain.

While the days are still hard and life won’t ever be normal, Jen says it’s a huge relief having Dr. Alexander and his team in her corner.

“Dr. Alexander is hopeful, but realistic,” Blair said. “That’s important.”

Jen now works as a volunteer at UMGCCC, comforting and supporting other patients going through the same things as her.  She also works closely with the Mesothelioma Applied Research Foundation, which is a non-profit “dedicated to ending mesothelioma and the suffering caused by it, by funding research, providing education and support for patients and their families, and by advocating for federal funding of mesothelioma research.”

Learn more about the Mesothelioma and Thoracic Oncology Treatment Center at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Center by clicking here.

Protect Your Skin This Summer

By Kirsten Bannan, System Communications Intern

As the summer progresses the initial sunburn has faded and it’s time to think about protecting your skin. Everyone wants that bronze glow that comes with a summer tan, but most people are sun picnot aware of the damage the sun can cause to your skin and your health. Here are some facts and tips that will help you protect your skin this summer.

Skin Cancer is the most common cancer in the United States. Most skin cancers are caused by exposure to Ultraviolet (UV) rays. The sun emits these rays and you can get extra exposure from using tanning beds or sun lamps. “People who use tanning salons are 2.5 times more likely to develop squamous cell carcinoma, and 1.5 times more likely to develop basal cell carcinoma. According to recent research, first exposure to tanning beds in youth increases melanoma risk by 75 percent” (Skin Cancer Foundation). There are two types of UV radiation that affect the skin: UVA and UVB. Both kinds of rays can cause skin cancer, weaken the immune system, contribute to premature aging of the skin, and cataracts (See our Cataract Awareness Article).

UVA Rays– they are not absorbed by the ozone layer and penetrate skin to contribute to premature aging. “They account for up to 95 percent of the UV radiation reaching the Earth’s surface” (Skin Cancer Foundation). UVA is the prevalent tanning ray; tanning itself is actually damage to the skin’s DNA. The Skin gets darker in an attempt to protect from further DNA damage.

UVB Rays– they are partially absorbed by the ozone layer and are the primary cause to sunburn. They play a very large role in the development of skin cancer. The most intensive UVB rays hit the Earth around 10am to 4pm from April to October.

There are protective measures that you can take to prevent against damage and skin cancer. Since the sun can damage your skin in as few as 15 minutes, it’s important to put sunscreen on when you know you will be outside for an extended period of time. Sunscreen works by absorbing, reflecting, or scattering sunlight. They contain chemicals that interact with the skin to protect it from UV rays.
Here are some other tips from the Centers for Disease Control and Prevention on sun safety:

A wet T-shirt offers much less UV protection than a dry one, and darker colors may offer more protection than lighter colors.

A regular T-shirt has an SPF rating lower than 15, so use other types of protection as well.

Sunglasses protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.

o Sunglasses that block both UVA and UVB rays offer the best protection. Most sunglasses sold in the United States, regardless of cost, meet this standard. Wrap-around sunglasses work best because they block UV rays from sneaking in from the side.

SPF. Sunscreens are assigned a sun protection factor (SPF) number that rates their effectiveness in blocking UV rays. Higher numbers indicate more protection. You should use a broad spectrum sunscreen with at least SPF 15.

Reapplication. Sunscreen wears off. Put it on again if you stay out in the sun for more than two hours and after swimming, sweating, or toweling off.

Cosmetics. Some makeup and lip balms contain some of the same chemicals used in sunscreens. If they do not have at least SPF 15, don’t use them by themselves.

Sunscreen is one of the best ways of protecting yourself from the sun’s harmful rays. Make sure to get a sunscreen that protects against UVA and UVB rays. Sunscreen labels that have “Broad Spectrum” means they protect against both kinds of rays. You also want to make sure to know the difference between “water resistant” and “waterproof”. The American Cancer Society says that “No sunscreens are waterproof or “sweat proof,” and manufacturers are no longer allowed to claim that they are. If a product’s front label makes claims of being water resistant, it must specify whether it lasts for 40 minutes or 80 minutes while swimming or sweating”. They recommend reapplying every two hours and even sooner if you are sweating or swimming.

No matter what summer activities you have planned this summer, make sure you protect your skin from the sun’s harmful rays. It takes 2 minutes to apply sunscreen and that can help save you from a lifetime of skin damage or even skin cancer.

Take a Sun Safety IQ Quiz from the American Cancer Society:
http://www.cancer.org/healthy/toolsandcalculators/quizzes/sun-safety/index’

Sources:
http://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm
https://www.epa.gov/sites/production/files/documents/sunscreen.pdf
http://www.cancer.org/cancer/cancercauses/radiationexposureandcancer/uvradiation/uv-radiation-avoiding-uv
http://www.cancer.org/cancer/news/features/stay-sun-safe-this-summer
http://www.skincancer.org/prevention/uva-and-uvb

Taking Treatment & a Half Marathon, Together, One Step at A Time

The relationship between a cancer patient and their care provider is a special one.  Between radiation therapy appointments, hours of chemotherapy, and even sometimes surgery and recovery, there’s not much that can strengthen this bond, besides running a half marathon.

Dana and Tiffani

But Tiffani Tyer, a nurse practitioner in Radiation Oncology at the University of Maryland Greenebaum Comprehensive Cancer Center (UMGCCC), and Dana Deighton’s journey started long before this year’s Maryland Half Marathon & 5K.

About 3 years ago Dana was diagnosed with stage IV esophageal cancer.  At 43 years old with 3 young children, it was, in Dana’s words, “unfathomable.” She traveled up and down the East Coast looking for a treatment plan that would give her the most hope. Many acted like she was naïve and unrealistic for even seeking out treatments beyond palliative chemotherapy.

After much deliberation, Dana settled on a plan of 8 cycles of chemotherapy at one local hospital. During this treatment, a friend introduced Dana to Mohan Suntha, MD, a radiation oncologist at UMGCCC.

Within an hour of getting Dana’s information, Dr. Suntha gave her a call. While he agreed the appropriate preliminary step was chemotherapy, he did not close the door on her like many others.  Dr. Suntha and Dana continued to check in with each other throughout her chemotherapy treatments to see how things were going.

In December 2013, after Dana finished chemotherapy, she learned she would not be considered for radiation or surgery by the hospital where she was initially treated. She was told that the data did not support it. She was devastated. Dana returned to UMGCCC, where Dr. Suntha and Tiffani were always willing to reassess her situation and provide guidance when obstacles seemed insurmountable.  Knowing that every case is different, he agreed to reevaluate her.

tiffani dana and dr sunthaAfter careful consideration and determining that her distant disease had indeed resolved, he offered her local treatment with chemotherapy and radiation targeting the primary site in her esophagus.  While the local treatment helped, the primary site still showed evidence of persistent disease at the end of her treatment.  To try to avoid major thoracic surgery, an endoscopic mucosal resection was attempted, but was unfortunately unsuccessful. Dana was again devastated. She felt like it was just another blow to her journey to health and she was running out of options.

Dr. Suntha and Tiffani encouraged Dana to stay hopeful. They agreed along with many other providers that indeed she was in a difficult position. After many tumor board discussions and repeat imaging studies to confirm her extent of local disease thoracic surgeon Whitney Burrows, MD, was consulted. He discussed surgical salvage to address her only site of cancer.  Albeit risky, with no guarantee of a survival benefit, it was her only remaining local treatment option.  Recognized as a long shot with a real possibility of acute complications related to such a long and complicated surgery, she willingly consented to undergo the esophagectomy. From Dana’s view the benefit far outweighed the risk. She believed in her team and her surgeon, whose expertise is well established in post chemoradiation patients. It proved to be a good choice and offered a huge reward.  Dana recovered well and was cancer free and feeling great–until July 2015.

It was then that a routine interval scan revealed a new lymph node mass in her Axilla (near the armpit) was biopsied and confirmed to be recurrent esophageal cancer.  Dana had resigned herself to more draining rounds of chemotherapy after another surgery could not remove all of the cancer.  But again, Dr. Suntha, Tiffani, and medical oncologist, Dan Zandberg, MD, always made sure all options were presented and considered.

tiffani zandberg and sunthaDana’s case was represented to  their colleagues at a tumor board meeting on the Friday before she was supposed to start chemotherapy.  Drs. Suntha and  Zandberg called her that evening to  recommend  immunotherapy, which harnesses the power of a  patient’s immune system to fight cancer.  After a sleepless night, Dana agreed.   She now receives treatments of Nivolumab every 2 weeks for at least a year.

Dr. Suntha has always recognized that there’s something unusual about Dana’s case, and has often asked, “Is there something different about her biology? We don’t know.”

Dr. Suntha, he also believes that Dana’s strong will and clear ability to advocate for herself has facilitated part of the success of her care.

dana and tiffaniThroughout these three years, Dana describes herself as lucky enough to continue her usual regimen of walking, running, and exercising consistently.  She donated money to the Maryland Half Marathon & 5K to fund cancer research in the past, but feeling much healthier and up to a new challenge, she promised to run it in 2016. She has always ran 10 milers in her hometown of Alexandria, Virginia, but knew those 3 extra miles of hills in the Half Marathon would be challenging.
Despite her reservations, in a partnership with Tiffani, the Radiation Oncology Greene Street Dream Team was born. On May 14th, Tiffani and Dana ran the entire race together (even though, according to Dana, Tiffani could’ve run circles around her).  To date, they’ve raised more than $10,000. They’ve taken every step together in cancer treatment and every step in the half marathon & 5K – a true bond that will continue.

Fundraising for the Maryland Half Marathon and 5K that supports this Radiation Oncology Dream Team and their patients continues until June 30th.

You can donate to Tiffani & Dana’s team here.

Greenebaum Cancer Center Recognizes Compassion, Humility in Two Staff Members

Two University of Maryland Marlene and Stewart Greenebaum Cancer Center staff members were recently honored with 2015 Greenebaum Compassion Awards.  Medical assistant Heather Thomas and clinical nurse Thi Nguyen, RN, were nominated by their coworkers for exemplifying the qualities of compassion and humanitarianism while providing care for their patients.

Marlene and Stewart Greenebaum, for whom the Cancer Center is named, established the special award in 2007 to recognize staff members who go well beyond their normal duties and demonstrate extraordinary compassion, hope and dignity.

Thomas, a medical assistant at the Stoler Outpatient Lymphoma clinic, received not just one nomination, but four. Sharon Otto, RN, Seung Tae Lee, MD, Jennifer Cash, RN, and Arnob Banerjee, MD, PhD, all described Thomas as willing to go the extra mile for her patients, no matter the circumstances. She has been known to call patients to see how they are feeling or even simply to wish them a Happy Birthday.

“[Thomas] anticipates their needs and really makes them feel understood and cared for,” Cash says. “She will stop whatever she is doing if a patient stops her to see if she can help them. She is a wonderful team player, and I have never heard her say ‘no’ to anyone.”

Otto describes Thomas as the “epitome of calmness” and adds “our patients, our staff and the physicians all feel safe and comforted when Heather is involved.”

Nguyen works in the Greenebaum Cancer Center’s aphaeresis lab , providing treatments such as stem cell collection, photophoresis and leukodepletion. Nominated by Kathy Holden, RN, Nguyen inspires her coworkers to strive for the outstanding level of commitment, empathy and passion she displays on a daily basis. Holden says Nguyen is always looking for ways to make her patients’ procedures more effective and less taxing. Her passion for healing goes beyond her written job description.

“During conversations about the sometimes long hours and overtime, Thi has expressed to me: ‘I don’t care about that. I think about the patient and how they need that to survive, so I will do it. I don’t even care if I get paid,’” Holden says.

Nguyen’s concern for the patient’s welfare also doesn’t go unnoticed by those she helps treat. Holden says she has seen patients with tears in their eyes, thanking Nguyen for “saving their lives.”  Nguyen also becomes “overwhelmed with heartbreak” when a client has complications, and “noticeably rejoices with them for reaching milestones for recovery.”

Greenebaum Cancer Center staff members nominate their own colleagues for the annual Compassion Awards, are nominated by and a committee representing various Cancer Center departments selects the winners. As award recipients, Nguyen and Thomas each received a $2,500 cash award, and had their names added to the Compassion Award display in the Stoler Pavilion waiting area.