Summer 2009 Edition Topics
Transcription
Summer 2009 Edition Topics
News and advancements in oncology from The Sandra & Malcolm Berman Cancer Institute at GBMC Summer 2009 In this issue: n Physicians Rocking the Oncology World n Genetic Counseling: Information is Power n Thoracic Oncology Center Streamlines Care A GBMC Publication • Summer 2009 From the Director Cancer Committee 2009 Looking back on the past allows us to better prepare for the future… Over the past decade, the oncology professionals at GBMC have made significant contributions to the field, playing leading roles in groundbreaking, national clinical trials that have led to new, targeted therapies for a variety of cancers. Through their diligent work and collaborative partnerships with national and local cancer organizations, our clinical staff and support professionals have greatly impacted public policy and have made it a mission to address quality of life and patient rights issues. It has also been one year since we dedicated the Cancer Institute in recognition of philanthropists Sandra and Malcolm Berman, individuals who have been instrumental in setting the course of growth and development for the many oncology services and support programs at GBMC. Supporters at all levels continue to provide us with the opportunity to pursue advancements in technology, outpatient facility enhancements and new services for our patients, as well as support the significant research component of our program. As you will read further on page 3 of this issue, GBMC’s oncology services are poised for significant growth, both physically and programmatically. I continue to look back on what we have achieved over the years and realize all that we have to look forward to as we plan for the future of cancer care at GBMC. Thank you for reading the latest issue of Greater Oncology Today. Warm regards, Gary I. Cohen, MD Medical Director The Sandra & Malcolm Berman Cancer Institute at GBMC n Baltimore, Maryland 21204 Chairman Gary I. Cohen, MD American College of Surgery Liaison Frank Rotolo, MD Administration Executive Director, Oncology Services Brian E. McCagh, FACHE Department of Medicine Hematology: John A. Nesbitt, III, MD Medical Oncology: Paul Celano, MD Marshall Levine, MD Palliative Care: Anthony Riley, MD Internal Medicine/Rehabilitation: Alan L. Kimmel, MD Department of Surgery General Surgery: Lauren A. Schnaper, MD Gynecology: Francis Grumbine, MD Thoracic Surgery: Neri Cohen, MD Urology: David S. Goldstein, MD Pathology Nathan A. Dunsmore, MD Pharmacy Dolores Dixon, PharmD, MBA, RPh Radiation Oncology Robert Brookland, MD Eva Zinreich, MD Radiology Lee Goodman, MD Oncology Service Line Medical Oncology/Cancer Center: Connie R. Herbold, CPC-I Cancer Registry: Sharon McIntire, MA, CTR Clinical Trials: Garnitha Ferguson, RN Human Genetics Institute: Jessica Adcock, MS Inpatient Oncology (Unit 45): Barbara Shaw, RN Oncology Support Services: Donna Lewis, RN, MS, CPC Community Outreach: Laura Chase, BS ACS Patient Navigator: Mindy Shifflett, BS Infusion Center: Dawn Stefanik, AA, MLT, RN, BSN, OCN Quality Assurance: Susan Fowble, RN, MS Radiation Oncology: Craig Randall, RTT Spiritual Support: Joseph Hart, M.Div. The Milton J. Dance, Jr. Center/Head and Neck Associates Barbara Messing, MA, CC-SLP, BRS-S Karen Ulmer, RN, CORLN ~ Greater Oncology Today is published semi-annually by the P.S. Greater Oncology Today is now a nationally recognized, award-winning magazine, receiving runner-up awards for “Most Improved Publication” and “Best Nonprofit Magazine” in the 2009 Ragan Recognition awards. 6701 North Charles Street Members shall be no less than seven in number and shall include a representative from the Departments of Surgery, Gynecology, Otolaryngology-Head and Neck Surgery, Internal Medicine, Diagnostic Radiology, Radiation Oncology, Pathology and such other members of the Medical Staff as deemed necessary to the effective function of the committee. n 443.849.2000 n www.gbmc.org GBMC includes Greater Baltimore Medical Center, Gilchrist Hospice Care and GBMC Foundation. Marketing and Communications Department of The Greater Baltimore Medical Center, a private, non-profit healthcare provider. Questions and comments regarding Greater Oncology Today articles should be submitted to [email protected] Director of Marketing: Michael P. Hartnett Publications Supervisor/Editor: Lisa J. Schwartz Contributing Editor: Gary I. Cohen, MD Contributing Writers: Judy Grillo, Jessica Schoeffield, Susan Walker Design & Layout: Dave Pugh Design Photography: Mimi Azrael, Tracey Brown Printing: Schmitz Press TA B L E O F C O N T E N T S 4 O N C O L O GY N U R S I N G Nurses Bring Expertise and Passion to Patients 20 2 VISION 6 IN FOCUS 8 O N C O L O GY CASE REVIEW 10 GENETICS 11 OF NOTE... 14 DA N C E C E N T E R 15 GIVING 16 AREA HIGHLIGHT 18 P H YS I C I A N SPOTLIGHT 12 AREA SPOTLIGHT H E A D & N E CK C A N C E R Women’s Surgical Center Caters to an Exceptional Clientele Physicians and Faculty Expand Treatment Options for Patients On the Cover: Sara Pai, MD, PhD, is spearheading groundbreaking research to help head and neck cancer patients (page 12). 21 NEWS 22 P RO F I L E S I N O N C O L O GY GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 1 VISION Investing inof Cancer theCareFuture at GBMC F OR GBMC’S SANDRA & MALCOLM BERMAN CANCER INSTITUTE, THE FUTURE IS ALL ABOUT program growth and development. Brian McCagh, Executive Director of the Cancer Institute, sees the blueprint for the future as “making a major investment not only in outpatient space and sophisticated technology, but also in the people, resources, programs and service excellence that make us stand out as the top community hospital-based cancer program in the state.” “Our focus is on the next 5 to 10 years,” explains Gary Cohen, MD, Medical Director of the Cancer Institute. “From a clinical standpoint, we realize the importance of investing in top oncology talent and leadership now so that we’ll continue to meet the ever-growing cancer care needs of the community well into the future.” In addition to recruiting top talent in the field, investing in expanded and renovated outpatient facilities and new technology, as well as programmatic development like tumor-site specific centers and enhanced survivorship and support programs, is a top priority. And, states Mr. McCagh, a continued emphasis on service excellence and providing patients with all of the resources needed throughout their cancer journey will certainly keep GBMC’s Cancer Institute well-positioned in the Baltimore region. The blueprint for growth in all areas of oncology includes: 2 ~ GREATER ONCOLOGY TODAY n Recruiting new, renowned medical oncologists, specialists and surgeons who will lead the program into the next decade and beyond n Expanding and renovating facilities for outpatient programs and services throughout Physicians Pavilion West n Adding six more chairs in the Infusion Center to treat an increasing number of patients n Relocating the pharmacy, which will be dedicated to chemotherapy, adjacent to the Infusion Center n Adding two new physician offices and up to eight new exam rooms in the Medical Oncology Center to accommodate and sustain the burgeoning medical oncology practice n Enhancing Radiation Oncology with the renovation of a third vault, as well as a new $3.7 million Rapid Arc linear accelerator that would make GBMC one of the first in the Baltimore market with such advanced technology ~ Summer 2009 The Future is Now If the expansion of the Milton J. Dance Jr., Head and Neck Center and Johns Hopkins Head and Neck Surgery at GBMC is any indication of what the future holds for oncology services, things are sure looking good. Completed in October 2008, the Dance Center increased in size from 3,000 square feet to 10,000 square feet in Physicians Pavilion West and features new, state-of-the-art diagnostic equipment in a healing environment. Additionally, Oncology Support Services’ new, modern space in the West Pavilion has enabled the team to expand support programs for adults as well as adolescents, including the development of a survivorship program. GBMC’s President and CEO Says Vision for Gro The vision for GBMC’s Cance r Institute — to in the region — be the preferred aligns with the community can overall vision fo This is just the beginning, very best medic cer program r the hospital. B al oncologists, sp y retaining and re ecialists and surg concludes Mr. McCagh. sophisticated pr cruiting the eons, and throug ograms and on h ongoing inve cology services, “What it all comes down to the best cancer st ment in th e Cancer Instit care available cl ute will continue ose to home an is this — being forward for example, in to deliver d throughout th cludes the curren e region. This in t $10 million re thinking and doing the Oncology Cente ve st ment, novation of the r, which features Sheila K. Riggs right things right while new, state-of-the expanded patien Radiation -art technology, t support areas. new infrastructu And, as we mov turning dreams space for the C re and e forward, plan ancer Institute s to incorporate in the West Pavi into reality.” n ad ditional lion will also ta Also important ke shape. to the growth of oncology servic opportunities of es is the establis f-campus. The hment of relati de velopment of st areas will allow onships and rategic partnersh GBMC to lend ips in our secon expertise and vi programs that m dary service able resources to ay be in need. A those hospitals nd, our relation at Johns Hopki an d cancer ship with the le ns provides our ading university patients with th oncology servic program e best of both ac es. ademic and un iversity-level GBMC has a lo ng history of de livering high-lev care in oncology el , recognized for years as one of top cancer cente th e rs in the nation by US News & World Report. T he need for this caliber of care in the community is clearly eviden t. We have set the course for conti nued growth so that the choice coming to the ve for ry best commun ity hospital-bas cancer program ed will be clear wel l into the future . Laurence M. M erlis GBMC Presiden t and CEO GREATER ONCOLOGY TODAY ~ wth is Clear Summer 2009 ~ 3 ONCOLOGY NURSING Barbara Shaw, RN, BSN, OCN, shares a smile with her patient on the inpatient oncology unit as she tends to his IV and checks to see how he is tolerating his treatment. 4 ~ GREATER ONCOLOGY TODAY ~ Summer 2009 T HE FIELD OF CANCER DIAGNOSIS AND treatment is evolving at an increasingly rapid rate. That can make it difficult for patients to gain access to the information they need to understand their treatment options and better manage the side effects they face. At GBMC, patients have an important resource they can rely on to provide that information and support — oncology certified nurses. Currently, 14 oncology nurses at GBMC have earned the certification, and several more are in the process of working toward this designation. To become certified, nurses must not only pass a rigorous test that covers all aspects of cancer care, they are also required to recertify every four years. Recertification requires that they earn at least 100 hours of continuing education or participate in equivalent professional development activities such as teaching or publishing or that they pass the test again. “Oncology nursing is a very specialized field,” explains Dawn Stefanik, AA, MLT, BSN, RN, OCN, who has been an oncology certified nurse since 1998 and is the nurse manager in GBMC’s Lois Harvey Miller Infusion Therapy Center. Ms. Stefanik is also a trainer for the national ONS Chemotherapy and Biotherapy course and is currently serving as the team leader for the national revision of the renewal course, which is required every two years to remain up-to-date in this area of practice. “There is a great deal to learn. Treatments are constantly changing and new ones are being developed. As oncology certified nurses, we have a wealth of knowledge we share with patients that can help improve their quality of life while undergoing treatment,” she adds. Barbara Shaw, RN, BSN, OCN, an oncology certified nurse in GBMC’s Joseph F. Keelty Inpatient Oncology Care unit, agrees. “We act as liaisons and advocates for our patients and can offer options such as medications to ease the nausea associated with some treatments. We bring the latest knowledge in the field of oncology to the table for patients and they look to us for in-depth information and support.” A Dual Perspective Kathy Robinson, RN, BSN, ONC and Dawn Stefanik, AA, MLT, BSN, RN, OCN, talk to patient Susan Grimmel about her treatment for breast cancer during one of her visits to the Infusion Center. Adele Hammerman sees the benefits of oncology certified nursing from both sides. The retired high school teacher received cancer treatment at GBMC and is also a public member of the board of the Oncology Nursing Certification Corporation (ONCC), the organization that oversees the certification process. In her role with the ONCC, she represents the views of the people who use the services oncology nurses provide. “Knowing your nurse has achieved oncology certification gives patients more confidence,” she believes. “You’re working with a specialist who is committed to providing the best and most up-to-date cancer care.” Having oncology certified nurses on staff also offers benefits to physicians. “Nurses are able to provide a higher level of support because they have extensive, detailed knowledge about the complete range of treatment options,” says Kathy Robinson, RN, BSN, OCN, GBMC’s department of outpatient oncology. “That helps our oncology team provide the best care to patients.” n GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 5 IN FOCUS GBMC’s New Thoracic Oncology Center: Streamlined Care for Lung and Esophageal G BMC’S NEW THORACIC ONCOLOGY CENTER PROVIDES patients with streamlined access to the complete spectrum of diagnostic and treatment options for lung and esophageal cancers. The center also offers the services of a navigator to guide patients and families through their journey. “Our goal is to bring together the best aspects of a multidisciplinary approach,” explains Neri Cohen, MD, PhD, Chief of GBMC’s Division of Thoracic Surgery. “The center serves as a single point of contact for patients and referring physicians. It also allows for the rapid transfer of information between members of the care team so we can develop an individualized, comprehensive diagnostic and treatment plan and put it into motion rapidly.” Services offered include: 6 n Rapid scheduling of appropriate appointments with cancer specialists n Full range of noninvasive and minimally invasive diagnostic testing n Surgery, focusing on minimally invasive approaches which speed recovery n Radiation, including conventional, 3D conformal, intensity modulated radiotherapy and stereotactic radiosurgery n Chemotherapy, including biologically targeted agents n Access to the entire range of clinical trials n Patient- and family-centered cancer care n Pulmonary and physical therapy rehabilitation ~ GREATER ONCOLOGY TODAY ~ Summer 2009 n Low-dose ultra-fast screening CT scans for patients with an increased risk of developing lung cancer n Consult reports faxed to referring physicians in one day or less The Patient Perspective Daniel Cronin, a 65-year-old man referred to the Thoracic Oncology Center by his otolaryngologist, experienced the benefits of the center’s approach. Within two weeks, he moved rapidly through diagnosis; he had a PET/CT scan and saw Dr. Neri Cohen who arranged for him to undergo a biopsy of the tumor in his left lung. One day after the biopsy, Mr. Cronin met with medical oncologist Marshall Levine, MD, and with the Radiation Oncology team (led by Eva Zinreich, MD) the following day. Thereafter, he began concurrent chemotherapy and radiation therapy, which he tolerated well and completed in January 2009. “The process moved so smoothly, there was very little I had to do,” says Mr. Cronin. “My daughter, an oncology nurse who works elsewhere, told me no one gets in to see the treatment team as quickly as I did. My level of anxiety would have been much higher without the guidance I received from the team at the Thoracic Oncology Center.” n For more information or a patient referral, contact the Thoracic Oncology Center at 443-849-3470. Cancer Patients Dr. Neri Cohen reviews a patient's images. He states that one of the many advantages of the new Thoracic Oncology Center is the ability to develop an individualized treatment plan and set it into motion rapidly. GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 7 ONCOLOGY CASE REVIEW GBMC’s Multidisciplinary Approach to Primary CNS Lymphoma “The hardest thing I had to do was go in for brain surgery because I could see the fear in the faces of my family and friends who were there for me.” R “At the Sandra & Malcolm Berman Cancer Institute, we see one or two patients per hospital” came at age 51. Following year with this particular condition,” says a year of flu-like symptoms that proDr. Donegan. “It is very aggressive and, if gressed to blurred vision and limb weakness, left untreated, most individuals will live he experienced two seizures in late 2005. less than six months. Age and the person’s This would be the beginning of more than physical condition a year of both supportive Robert B. Donegan, MD at the time of diagand definitive therapies. nosis are the two A brain MRI revealed most important a 3 cm mass in Mr. prognostic factors. McDonald’s right Both of these were temporal lobe of the in Mr. McDonald’s brain, suspicious for a favor.” primary brain tumor. He The standard underwent a craniotomy treatment for and resection of the PCNSL is brain mass and, rather chemotherapy, than a primary brain specifically hightumor, it proved to be a dose methotrexate diffuse large B-cell non(HD-MTX), Hodgkin lymphoma. which may be Additional testing combined with revealed no evidence of other chemotherapy agents. Radiation residual lymphoma within the brain or therapy to the brain is generally avoided as lymphoma outside of the brain, although initial therapy due to its potential toxicity an asymptomatic mass was incidentally but may be beneficial later, particularly in noted within his right kidney, suspicious those who recur following chemotherapy. for primary kidney cancer. OBERT MCDONALD’S “FIRST TASTE OF A A Rare Find and Swift Action He was referred to GBMC medical oncologist Robert B. Donegan, MD, who established the diagnosis of Primary Central Nervous System Lymphoma (PCNSL). PCNSL arises within, and is confined to, the central nervous system. PCNSL is quite rare, accounting for only five percent of all brain tumors and an even lower percentage of all lymphomas. 8 ~ GREATER ONCOLOGY TODAY ~ Summer 2009 Following the craniotomy, Mr. McDonald began high-dose methotrexate. This initially required hospitalization for four-to-five days several times a month, but after three months the chemotherapy was temporarily halted. Ronald F. Tutrone, MD, GBMC’s Division Head of Urology, then performed a nephrectomy and removed a Stage I carcinoma of the kidney that was unrelated to the lymphoma. Not Out of the Woods Yet In May 2006, the high-dose methotrexate resumed once per month, and Mr. McDonald went on to complete a full year of chemotherapy. However, halfway through this treatment, he was having difficulty seeing out of his left eye and it was found that the lymphoma had recurred within the eye. C.P. “Pat” Wilkinson, MD, Chairman of GBMC’s Department of Ophthalmology, performed a vitrectomy, a surgical procedure that removes some or all of the eye’s vitreous humor. In Mr. McDonald’s case, lymphoma cells were found in the vitreous humor. This was followed by 12 doses of radiation therapy to the left eye under the direction of Eva Zinreich, MD, Radiation Oncologist. These treatments resulted in a complete response and an eventual return of normal vision. “It was nerve-racking seeing all these different doctors for different treatments week after week, but Dr. Donegan was always upbeat, and we would talk about sports and rock and roll music,” recalls Mr. McDonald. “He is a great person besides being a great doctor, and he kept me grounded.” Mr. McDonald’s chemotherapy treatments ended in February 2007 and, to date, he shows no signs of recurrence of either cancer. Since completion of his treatment, he undergoes a complete physical exam, an eye exam, an MRI of the brain, and a CT scan of the kidney every four-to-six months. “Now that two years have passed, we are quite optimistic about Mr. McDonald’s prognosis, and while we sure like seeing his smiling face, we will eventually be able to reduce the frequency of his follow-up,” says Dr. Donegan. Moving on with Life as Usual “The hardest thing I had to do was go in for brain surgery because I could see the fear in the faces of my family and friends who were there for me,” says Mr. McDonald. “But, as time went on, it was so important that the GBMC doctors, nurses and staff are more than skilled professionally, they are incredible people who will do anything to make your situation a little easier.” Robert McDonald is working and back to his life. “I just love getting up in the morning, letting the dog out and happily getting on with my day,” he says. n GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 9 GENETICS Genetic counselor Jessica Adcock encourages patients to find out as much as they can about their family health history, saying, “Information is power.” Genetic Counseling Helps Patients Build a Strategy to Combat Breast Cancer W HILE INHERITED FORMS OF BREAST CANCER PLAY A ROLE IN ONLY ABOUT 5 TO 10 percent of women diagnosed with the disease, the presence or absence of the BRCA-1 or 2 gene mutations can form the foundation of a tailored treatment and surveillance strategy. Women with the mutation are at a higher risk for breast cancer, a second breast cancer, as well as for ovarian cancer, so more vigilant screening and prophylactic surgical options can become key components of their cancer-combating strategy. “If a woman is diagnosed with breast and/or ovarian cancer younger than age 50, has a family history of breast and/or ovarian cancer or has a personal history of more than one primary type of cancer, she may be a good candidate for genetic counseling,” says Jessica Adcock, Genetic Counselor at GBMC’s Harvey Institute for Human Genetics. “Those are characteristics that can suggest a genetic component to the occurrence of the cancer.” The genetic counselors at the Harvey Institute perform an in-depth risk assessment which includes the patient’s family and individual history to determine if there might be a genetic predisposition to breast cancer. If a genetic element appears to be involved, they offer the patient the option of pursuing genetic testing. Anna Marie Bavett, who was diagnosed with breast cancer at 43, underwent the counseling and testing because she wanted to know if she had an increased risk for ovarian cancer. “I had the testing for my peace of mind and my family’s,” she says. “I wanted to seek proactive treatment if my tests showed I did have the genetic mutation. I was both surprised and relieved to learn I didn’t.” “For many of the patients we see, information is power,” says Ms. Adcock. “They use it to make medical decisions and learn if their children and siblings might be at risk for cancer so they can encourage them to be more proactive with screenings and cancer risk reduction.” Adds Ms. Bavett, “The counseling and testing was a very positive experience. It provided information that helped me make decisions on how I would continue my fight against breast cancer. For me, it was the last piece of the puzzle.” n To learn about the genetic counseling and testing services available at the Harvey Institute or to refer a patient for counseling, call 443-849-3131. 10 ~ G R E A T E R O N C O L O G Y T O D A Y ~ Summer 2009 OF NOTE... McCagh Appointed To State Cancer Council Gary Cohen, MD, Honored for Medical Excellence Lymphedema Center Gets Facelift, New Space Brian McCagh, FACHE, GBMC’s Executive Director of Oncology Services, was appointed by Governor Martin O’Malley to serve on the Maryland State Council on Cancer Control. The council’s purposes include advising government officials and the general public on state policies and programs, coordinating and promoting programs that address the cancer needs of Marylanders and reviewing existing and planned cancer programs. He has provided oversight of GBMC’s oncology service line since May 2007 and works closely with Gary Cohen, MD, Medical Director of the Sandra & Malcolm Berman Cancer Institute at GBMC. Gary Cohen, MD, Director of the Sandra & Malcolm Berman Cancer Institute at GBMC, was the 2008 honoree of the Dorothy Friedman Caplan Guild, a nonprofit fundraising organization for cancer and leukemia research. Dr. Cohen was recognized for being an outstanding medical oncologist and clinical researcher in the community. The new and expanded Greater Baltimore Lymphedema Center and new Oncology Rehabilitation Center offer comprehensive services for recovering cancer and lymphedema patients. The facility features private exam and treatment rooms, physician and therapist offices, an education area as well as a rehabilitation gym. A special reception was held at Harbor Court on November 29. The Foundation made a generous donation of $25,000 for patient enhancements in the Lois Harvey Miller Infusion Therapy Center, including specialized comfort recliners for chemotherapy patients and flat screen TVs for 19 patient bays. Lymphedema occasionally occurs in recovering cancer patients who have undergone lymph node surgery or radiation, but frequently goes undiagnosed because its symptoms can be mistaken for other conditions. Working in conjunction with GBMC’s Sandra & Malcolm Berman Cancer Institute, lymphedema therapists are available to monitor and coordinate patients’ exercise regimens with the types of chemotherapy they received, ensuring safety and success. n VVVVV VVVVVV VVVVV VVVVVV TheBoutique V Sometimes it’s the small things that can make a woman undergoing cancer treatment feel better…a great-fitting wig, a touch of blush on the cheeks and a little extra pampering. That’s just what they’ll find at GBMC’s Boutique, where the primary focus is on the special needs of women with cancer, alopecia and specialized skin care conditions resulting from scars, burns or laser treatments. The Boutique offers wigs and wig fittings, scarves and hats for hair loss, breast fittings (bras and prosthetics), products for skin care and overall image consultation. Helping women look good and feel great about themselves… The Boutique’s cosmetologist, Linda Kurgan, puts great emphasis on helping patients look good and feel well. Other services provided include shampoos, haircuts, styling, manicures and waxing services. Next time your patient needs that little extra pampering, send her to The Boutique. Hours of Operation: Monday-Friday, 8:30 a.m. - 5:00 p.m. Gift certificates are available. All services are by appointment only. Call 443-849-8700 or e-mail Lynne Caddick, Boutique Manager, at [email protected]. GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 11 HEAD & NECK CANCER GBMC Physicians and Johns Hopkins Faculty Expand Treatment Options for Head and Neck Cancer Patients M EMBERS OF JOHNS HOPKINS HEAD AND Neck Surgery at GBMC are involved in a range of studies and clinical trials that have the potential to open doors to new treatment options for head and neck cancer. From therapeutic vaccines to genetic explorations, the studies help to strengthen the understanding of head and neck cancer and to pioneer new treatments. “Engaging in a variety of research creates the potential to make great strides in the treatment of head and neck cancers.” Joseph Califano, MD, FACS, Professor, Department of Otolaryngology–Head and Neck Surgery at The Johns Hopkins University and surgeon at Johns Hopkins Head and Neck Surgery at GBMC and the Milton J. Dance Jr., Head and Neck Center, is enrolling patients in a Phase II clinical trial of the erectile dysfunction drug tadalafil to reverse immune suppression in the environment around head and neck tumors. The drug increases nitric oxide blood levels, which in turn combats the suppression of tumor-killing cells. A previous study with sildenafil, another drug from the same class, found that the treatment resulted in significant tumor regression. Another study by Patrick K. Ha, MD, FACS, surgeon at Johns Hopkins Head and Neck Surgery at GBMC and Assistant Professor of Otolaryngology–Head and Neck Surgery at Johns Hopkins, is focusing on the genetic process of methylation in a rare form of head and neck cancer, adenoid cystic carcinoma. The study, which is in a very early stage, has identified several gene 12 ~ G R E A T E R O N C O L O G Y T O D A Y ~ Summer 2009 targets for the disease that have not been described before. Because there is no effective chemotherapy for adenoid cystic carcinoma and the progression of the disease can be highly unpredictable, gaining an understanding of the mechanism of the cancer is key to developing new treatments. Patients at the Dance Center have the option of including a recently FDAapproved monoclonal antibody therapy in their treatment regimen. GBMC medical oncologist Marshall Levine, MD, FACP, notes that cetuximab is being used to treat squamous cell head and neck carcinomas in two settings — as part of a combined regimen with chemotherapy for metastatic and recurrent head and neck cancer and as primary management of locally advanced cancer being treated with radiation. For some patients, cetuximab, which is less toxic than chemotherapy, may improve quality and quantity of life. Clinical trials showed that patients with oropharangeal squamous carcinoma gained a significant advantage with the addition of cetuximab over treatment with radiation alone. In addition, a study is available through the Eastern Cooperative Oncology Group to patients with recurrent or metastatic head and neck cancer. It involves randomization between chemotherapy alone versus chemotherapy and the anti-angiogenic drug bevacizumab. The goal is to determine if interrupting the blood supply to cancer cells makes standard chemotherapy more effective. Sara Pai, MD, PhD, Assistant Professor, Johns Hopkins Department of Otolaryngology — Head and Neck Surgery, is in the final stages of launching a clinical trial with a therapeutic DNA vaccine which targets head and neck cancers caused by the human papillomavirus (HPV). The vaccine works by boosting the immune system to recognize and kill HPV-infected cancer cells, which may have been missed by traditional treatments such as chemotherapy, radiation, or surgery. The potential of the DNA vaccine in treating microscopic locoregional and/ or micrometastatic disease is demonstrated in preclinical animal models in which complete regression of established tumors was achieved after DNA vaccination. In addition, Dr. Pai is leading a study that monitors the immune status of head and neck cancer patients after they complete chemoradiation therapy. The study is aimed to determine if chemoradiation treatment suppresses the immune system. The information will allow Dr. Pai and her colleagues to determine the optimal timing to administer the DNA vaccine after patients complete chemoradiation therapy and, thus, ensure that patients will be able to respond to and, possibly, benefit from the immune boosting vaccine. “Engaging in a variety of research creates the potential to make great strides in the treatment of head and neck cancers,” says Dr. Ha. n GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 13 DANCE CENTER Dysphagia in Cancer Patients By Barbara Messing, MA, CCC-SLP, BRS-S; Melissa Walker, MS, CCC-SLP; Jaclyn Trachta, MS, CCC-SLP; and Keri Culton-Ryniak, RD, LDN, CNSD D YSPHAGIA IS A TERM DESCRIBING A swallowing difficulty or disorder. Although many individuals may experience dysphagia, 25 percent of patients with cancer experience treatment-related side effects that affect swallow function. This number increases dramatically in patients undergoing treatment for head and neck cancer. Trends in cancer treatment include organ preservation treatment protocols often involving chemotherapy and radiation; common side effects of these treatments include mild to severe mucositis (ulcerations, sores in the mouth, throat, esophagus), pain with swallowing, dry mouth and changes in saliva viscosity, trismus (restricted jaw opening), diminished or altered sense of taste, disuse muscle atrophy and complications such as esophageal stricture or narrowing. Surgery to remove a tumor from the patient’s mouth, throat or esophagus may result in significant anatomical changes that alter the patient’s swallow function. Barbara Messing, Clinical Director of the Dance Center, performs a videoflouroscopy Modified Barium Swallow (MBS) study, which monitors the flow of liquid barium through the oral cavity, pharynx and the esophagus of her patient. Dietary Concerns Surround Dysphagia Patients A patient with cancer may exhibit an inability to eat or demonstrate a reduced ability to take food or liquids because of related problems, such as nausea, tumor pain, diminished appetite, depression and other medical conditions. Comprehensive dysphagia assessment is necessary to determine the least restrictive diet that the patient will safely tolerate to maintain adequate nutrition and hydration needs. Early and late effects of treatment place patients at risk for swallowing problems during and well after their cancer treatments have ended. Monitoring of swallowing function and nutritional status is critical. Common complications that occur as a result of a swallowing disorder include malnutrition and dehydration, aspiration pneumonia and other potential pulmonary complications, airway compromise, poor quality of life, and even death. Malnutrition and dehydration may impact a patient’s ability to successfully navigate treatment in that patients may experience increased toxic side effects that may interrupt treatment, require hospitalization or discontinuation of treatment. Patients who are malnourished do not recover as well from treatment-related side effects. 14 ~ GREATER ONCOLOGY TODAY ~ Summer 2009 GIVING A Gift of Technology Provides Many with the Tools for Early Detection F OR ARLENE HADDOCK, HELPING OTHERS GET THE BEST SCREENING FOR Lateral view of a Modified Barium Swallow Study (MBS). MBS is fluoroscopic imaging of swallow structures and function that provides important information on patterns of impairment of the swallowing mechanism. Diagnosis and Treatment of Swallowing Disorders Swallowing disorders are diagnosed and treated by a speech pathologist. Common assessment methods include clinical evaluations, x-ray guided swallowing studies (modified barium swallow studies) and endoscopic examination of swallowing (fiberoptic endoscopic evaluation of swallow). The treatment of swallowing disorders typically involves a combination of modalities, such as diet modification, safe swallowing strategies, rehabilitative exercises, medication and possibly surgery. Patients undergoing cancer treatments are at risk for malnutrition and often benefit from consultation with a registered dietitian as well as a speech pathologist. The registered dietitian assesses current nutritional status and provides recommendations for maximizing dietary intake. n For more information about swallowing disorders or to schedule a nutritional consultation during or following cancer treatments, contact the Milton J. Dance, Jr., Head and Neck Center at 443-849-2087. breast cancer was paramount in her efforts to provide GBMC’s Sandra and Malcolm Berman Comprehensive Breast Care Center with the funds needed to purchase sophisticated digital mammography equipment. Ms. Haddock, who was treated for breast cancer at GBMC, bravely battled the disease for six years before she passed away in April 2008. Ken Haddock explains that his wife realized that the center had a need for digital mammography. Because this was so close to her personally, she felt it was important to help make this happen. And indeed, she did. Through Ms. Haddock’s philanthropic foundation, The Louis Berkowitz Family Foundation, a $25,000 grant was given to GBMC for the purchase of digital mammography equipment. The Foundation has also generously provided funding for other GBMC initiatives such as the Lung Cancer Early Diagnosis Program, which provides at-risk individuals with low-cost lung cancer screening. Ms. Haddock’s journey with breast cancer spanned six years, including hormone therapy, a lumpectomy and later a mastectomy, as well as four to five courses of chemotherapy. While the disease would eventually overcome the heroic efforts of her oncology team, Mr. Haddock recalls her strength through it all. In the end, he says, “Arlene wanted to help other women with breast cancer as much as she could.” n Arlene and Ken Haddock GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 15 AREA HIGHLIGHT Fighting Breast Cancer is a amilyAffair F J J ULIE NIEHAUS REMEMBERS THE SHOCK AND FEAR SHE FELT WHEN SHE RECEIVED “THE NEWS.” At age 42, a surgical biopsy confirmed what her mammogram had detected — ductal carcinoma of the left breast. “The hardest thing was telling my daughters because I didn’t want them to worry,” she says. For her sister Kelly, a mother of three, the news was a wake-up call that she was months behind schedule for her annual mammogram. She quickly made an appointment and, just days before Thanksgiving 2006, she too was diagnosed with ductal carcinoma at age 45, just six weeks following Julie’s diagnosis. While Julie and Kelly were prescribed different treatment plans, both required surgery and chose to schedule their initial surgical procedures on the same day with Frank Rotolo, MD, FACS, breast oncologist at GBMC. Kelly recalls being surrounded by supportive family members that morning but says that throughout this difficult time there were questions and concerns that only Julie could truly understand. The range of breast cancer treatment choices includes surgery and may be followed by combinations of radiation, chemotherapy and hormone therapy to reduce estrogen production. Julie underwent a bilateral mastectomy in January 2007 and within six months completed reconstructive plastic surgery with Brent C. Birely, MD. She is currently taking Tamoxifen, an adjuvant therapy to help prevent the development and recurrence of breast cancer. Following three lumpectomies, Dr. Rotolo performed a simple mastectomy on Kelly to ensure complete removal, which was followed by reconstructive plastic surgery with Sheri Slezak, MD. Both women return to GBMC at six-month intervals for follow-up exams. “While I always felt like I was in good hands at GBMC, it was really a blessing that my sister Kelly and I had each other to talk to throughout the entire experience,” adds Julie. “I would have felt much more alone without her.” Making aChoice Making a Choice Following treatment, Julie and Kelly chose to take their journey with cancer one step further “for all the women in our family.” In the spring of 2008, they underwent genetic testing to determine if they had inherited certain gene alterations that increase risk for breast and/or ovarian cancer. Both sisters tested negative and do not have the altered gene. “We know that genes are not the only factor that affects cancer risk, but we were pleased to head home and give our families this positive news,” says Kelly. n 16 ~ GREATER ONCOLOGY TODAY ~ Summer 2009 StayPositive Words to Live By: “Stay Positive” Julie’s daughter Allie, then 17, found her own means of support for what she describes as an overwhelming situation. “When my mom told me about her cancer diagnosis, she said that the key thing to remember was to stay positive,” says Allie Niehaus. Later that year, in her college entrance essay, Allie explained how she chose to live by this advice. As her mother faced a bilateral mastectomy and reconstructive surgeries, Allie spent a great deal of time with her sister, brothers and close friends while concentrating on school to avoid thinking about everything that could potentially go wrong. Allie admits that she benefited in many ways by keeping herself focused during this harrowing time. In her essay, she expressed how she ultimately discovered just how important family and good friends are during difficult times “to give you advice, and encouragement, and to listen to you cry when it’s too much.” Now an English major at Towson University, Allie plans to teach high school but aspires to be a college professor one day. “Attitude does change a situation, and by continuing to follow my mom’s advice to stay positive, I will be able to achieve the level of success I want in college, as well as in life,” says this wise young woman. Julianne Niehaus’s positive attitude helped her family, including daughter Allie (right), cope during her battle with breast cancer. GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 17 PHYSICIAN SPOTLIGHT Robert K. Brookland, MD Chairman, GBMC Department of Radiation Oncology A volunteer for the American Cancer Society (ACS) since 1984, Dr. Brookland has served as Chairman of the Maryland Division of the ACS, which grew to become the Mid-Atlantic Division then the South Atlantic Division under his tenure. He is currently on the Society’s South Atlantic Division Board of Directors. “The American Cancer Society is a community-based organization that helps people at a grassroots level through education, advocacy and services, but also funds research that has led to findings such as the Pap test and Tamoxifen,” says Dr. Brookland. “I’m proud to volunteer for an organization that does so much in the fight against cancer.” I NSIDE THE WALLS OF THE SANDRA & MALCOLM BERMAN Cancer Institute, many patients begin their journey with cancer and later celebrate survivorship thanks to the oncology professionals who make a difference each and every day. Outside of these walls, these same professionals are playing vital roles in affecting positive change in the field of oncology, volunteering their professional and personal talents outside the spectrum of their day-to-day patient care responsibilities. Drs. Robert Brookland, Paul Celano and Frank Rotolo’s leadership with organizations at national and regional levels impacts cancer policy and initiatives that serve the best interests of their patients. 18 ~ G R E A T E R O N C O L O G Y T O D A Y ~ Summer 2009 Among the many ACS initiatives that Dr. Brookland has played a role in is the Patient Navigator Program. Launched approximately two years ago in the South Atlantic Division, it is now approaching 30 sites across the region. “Navigators are full-time Society employees who go through rigorous training with the ACS and the hospital partner to assist cancer patients through the complex maze of information and resources,” he says. Here at GBMC, ACS patient navigator, Mindy Schifflet, is dedicated to helping cancer patients and their families connect with the resources and information they need, from support services to catastrophic health planning. Dr. Brookland is a past winner of the Society's highest honor, the St. George National Award, in recognition for his outstanding service and dedication. Paul Celano, MD, GBMC Division Head, Medical Oncology Frank Rotolo, MD, FACS, Surgeon and Cancer Liaison Physician Paul Celano, MD, joined GBMC in 1993 following nearly a decade at Johns Hopkins. Committed to delivering compassionate and quality care to his patients, he also looks for innovative and effective ways to bring preventive measures and delivery of care in medical oncology even further through his work with the Maryland and District of Columbia Society of Clinical Oncology (MDCSCO). Fellowship in the American College of Surgeons (ACOS) has led Dr. Frank Rotolo to more than 15 years of service as a Cancer Liaison Physician (CLP) with the Commission on Cancer (CoC). As a CLP, Dr. Rotolo manages clinically related cancer activities, supports GBMC’s compliance efforts with CoC standards, facilitates patient and community activities and coordinates with the American Cancer Society (ACS). Recently elected President, Dr. Celano has been a member of MDCSCO since its inception in 1993. During this time, he served on the Executive Board and as Representative for MedChi, the Maryland State Medical Society. He has also served as the Maryland State Chair of Cancer Liaison Physicians for the past seven years. As State Chair, he is the key contact in Maryland for programs and activities of the CoC, serves on the local ACOS Chapter Council and hosts an annual statewide CLP meeting. “The organization adds a different dimension to my work,” says Dr. Celano. “We represent and support physicians who treat people with cancer, but of equal importance is our goal to educate the public, government bodies, insurance carriers, and other healthcare providers about appropriate cancer prevention measures and appropriate standards of care in oncology.” These goals are met through a number of continual, diverse initiatives such as meetings with state legislators to advise on upcoming legislation that directly impacts patients, and an annual Cancer Forum with a number of hospitals to offer an educational series to patients and family members. During the past year, Dr. Celano was also instrumental in obtaining a grant from the American Society of Clinical Oncology to develop a web-based resource for Maryland and District of Columbia oncology professionals. This effort will provide a web site offering a collective calendar for posting oncology-related events, as well as a means for sharing information on clinical trials, research findings and reimbursement issues. “I think of it as Facebook for oncologists and look forward to building an active community across oncology disciplines throughout the region,” says Dr. Celano. “I’m very pleased that Maryland has one of the highest representations on the Commission on Cancer with 34 of 35 hospitals participating in collaborative efforts at a variety of different levels,” says Dr. Rotolo. “One of our major efforts is to utilize the National Cancer Database (NCDB), a joint program of the CoC and the ACS. It represents more than 20 million records and helps us to illustrate the quality of cancer care in the state as well as identify areas for improvement.” According to Dr. Rotolo, every GBMC patient with cancer is registered in the NCDB, and 80 percent of NCDB registrants are treated at 25 percent of the hospitals enrolled in the Commission. During the past year, Dr. Rotolo has also served on a subcommittee determining physician staging requirement changes for cancer patients. n GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 19 AREA SPOTLIGHT Women’s Surgical Center Caters to an Exceptional Clientele F OR PATIENTS WITH BREAST OR GYNECOLOGIC CONDITIONS, GBMC’S WOMEN’S SURGICAL Center (WSC) provides a wide range of diagnostic and treatment options in a compassionate environment. From admission and preoperative preparation to post anesthesia recovery, the staff of 42 supports each of the more than 20 patients it serves daily. WSC employees work in concert with personnel from other GBMC departments such as radiology, anesthesiology, laboratory/pathology and oncology, for every procedure. Approximately 10 percent of WSC’s surgical volume is comprised of breast cancer surgeries, most of which are performed by surgeon Lauren Schnaper, MD, FACS, in addition to Scott Maizel, MD, FACS, and Frank Rotolo, MD, FACS, in one of the six operating rooms, specially equipped for female-centric procedures. According to Laura Perdue, RN, MS, CNOR, Clinical Director of the Women’s Surgical Center, the single-gender setting is ideal for patients facing the types of procedures performed there, which can include hysterectomy and mastectomy. “The sensitive and sometimes emotional nature of these surgeries makes it even more important for us as caregivers to help comfort our patients and afford them as much attention as possible,” she says. Dr. Schnaper, for example, utilizes the skills of a dedicated surgical team — including an operating room nurse, anesthesiologist and surgical technician — to assist her when she performs breast cancer surgery at WSC. The members’ familiarity with one another allows them to anticipate each other’s needs, which helps the team function more accurately and efficiently. “Patients appreciate the fact that our team works together every day,” Dr. Schnaper explains. “They sense how well we know each other and how much we respect each other.” The Women’s Surgical Center Breast Surgery Team includes (left to right): Dr. Shelly Hairston-Jones, anesthesiologist; Dr. Lauren Schnaper, surgeon; Liz Germeroth, RN; and Patricia Brock-Johnson, surgical technician. 20 ~ The benefits of privacy, dedicated support and teamwork are not exclusive to breast cancer patients, however. The sole focus on women’s surgeries allows caregivers throughout WSC to develop a greater understanding of their patients’ needs. Whether preparing for a loop electrosurgical excision procedure (LEEP) to remove cervical cancer or recovering from a lumpectomy, Ms. Perdue notes, “Women can take comfort in the fact that they will not only receive expert care here, but highly personalized service as well.” n GREATER ONCOLOGY TODAY ~ Summer 2009 NEWS Surviving Cancer in the 21st Century O N SATURDAY, FEBRUARY 21, 2009, RENOWNED A U B U C U D U E U F U G U H U oncology specialists at GBMC came together for the first annual cancer conference, “Surviving Cancer in the 21st Century,” exchanging a wealth of information and scientific knowledge with fellow oncology and healthcare professionals and clinicians from around the region. The comprehensive conference covered topics such as diagnosis, screening and treatment options for a wide variety of cancers including breast, prostate and colon. Featured speakers focused on a wide range of important topics in cancer care including appropriate methods of screening and early detection; new, targeted systemic therapies; the role of genetics in cancer; and long-term survivorship issues. Speakers included: A Jessica Adcock, MS, genetic counselor with the Harvey Institute for Human Genetics; Topic: Genetics of Cancer B Paul Celano, MD, Chief, Division of Medical Oncology; Topic: Breast Cancer Survivorship: Bridging the Gap between Primary Care and Oncology C Gary Cohen, MD, Medical Director, Berman Cancer Institute; Topic: Cancer Therapy: New Targets, New Arrows D Judy Destouet, MD, Diagnostic Radiology/ Advanced Radiology; Topic: Tomosynthesis Mammogram Tomography E Donna Lewis, RN, MS, CPC, Manager, Oncology Support Services; Topic: Survivorship F Loralie Ma, MD, Diagnostic Radiology/Advanced Radiology; Topic: MRI of the Breast G Harold Tucker, MD, Vice Chief of Staff, Gastroenterologist; Topic: Colon Cancer Screening – Current Guidelines, Future Possibilities H Ronald Tutrone, MD, Division Head, Urology; Topic: Updates in Prostate Cancer Screening, Treatment and Research n GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 21 PROFILES IN ONCOLOGY MEET THE ONCOLOGY SPECIALISTS at GBMC’s Sandra & Malcolm Berman Cancer Institute THORACIC ONCO LO O C N O L A C I D E M GY FACP hen, MD, o C I. y r a G & Malcolm tor, Sandra c e ir D l a ic Med te y Hematolog ncer Institu & y g lo o c n Berman Ca ical O ied in Med Board-certif o, MD Paul Celan gy ical Oncolo d e M f o d a e ology Division H edical Onc M in d ie if rt Board-ce D tology audhry, M y & Hema g lo o c n O Madhu Ch l ica ied in Med Board-certif negan, MD Robert Do y Hematolog & y g lo o c n ical O ied in Med Board-certif D, FACP Levine, M . A ll a h rs ncology Ma Medical O in d ie if rt e Board-c rmation: ontact info C l a r e t n e G harles Stree 6569 N. C MD 21204 Baltimore, 051 443-849-3 22 ~ G R E A T E R O N C O L O G Y T O D A Y ~ Summer 2009 LOGY Neri Cohe n, MD, Ph D Division H ead of Tho ra cic Surgery Board-certif ied in Tho racic Surgery Steven Mil ma Board-certif n, MD ied in Tho racic Surgery General C ontact Info rm 6569 N. C harles Stree ation: t Baltimore, MD 21204 443-849-3 470 RADIATION ONCOLOGY Robert Brookland, MD Radiation Chairman, Department of Oncology n Oncology Board-certified in Radiatio Albert Blumberg, MD n Oncology Board-certified in Radiatio & Therapeutic Radiology Eva Zinreich, MD utic Radiology Board-certified in Therape tion: General Contact Informa 6701 N. Charles Street Baltimore, MD 21204 443-849-2540 d. , Dr. Zinreich, Dr. Brooklan Left to right: Dr. Blumberg BREAST CENTER Lauren Schnap er, MD, FACS Director, Sandr a and Malcolm Berman Compr Board-certified ehensive Breast in General Surg Care Center ery Scott Maizel, M Director, Breas D, FACS t Cancer Risk A ssessment Prog ram Board-certified in General Surg ery H. Alexander M unitz, MD Director, Pavilio n Imaging Cen ter and Directo of the Sandra an r, Imag d Malcolm Ber man Comprehen ing Division Board-certified in Diagnostic R sive Breast Care adiology Center Judy Destouet Chief of Mamm , MD ography for Adv anced Radiology Board-certified in Radiology General Conta ct Information : 6701 N. Charl es Street, Baltim ore, MD 21204 n 443-849-2600 GREATER ONCOLOGY TODAY ~ Summer 2009 ~ 23 PROFILES IN ONCOLOGY (continued) JOHNS HOPKINS HEAD & NECK SURG John R. Saunders, Jr., M D, FACS Medical Director, Milton J. Dance, Jr., Head and Neck Center Board-certified in Surgery Ray Gervacio F. Blanco , MD Board-certified in Surgery Joseph A. Califano, III, MD, FACS Board-certified in Otolaryn gology Patrick K. Ha, MD, FA CS Board-certified in Otolaryn gology General Contact Informa tion: 6569 N. Charles Street Baltimore, MD 21204 443-849-8940 ERY AT GBMC Left to right: Dr. Ha, Dr. Blanco, Dr. Saunders, Dr. Califano. URO ONCOLOGY GYN ONCOLOG Y AMERICAN COLLE OF SURGEONS (A GE COS) LIAISON D umbine, M Francis Gr partment De Chairman, gy c e s of Gyn olo in Obstetric d ie if rt e -c rd a Bo ology and and Gynec y ic Oncolog Gynecolog tion: ct Informa ta n o C l a r Gene t harles Stree 6569 N. C MD 21204 Baltimore, 765 443-849-2 24 ~ G R E A T E R O N C O L O G Y T O D A Y ~ Ronald Tutrone, MD Division Head of Urology Board-certified in Urology tion: General Contact Informa 6535 N. Charles Street Baltimore, MD 21204 410-825-5454 Summer 2009 Frank Roto lo, MD, FA CS Board-certif ied in Surg ery General C ontact Info rmation: 1205 York Road Lutherville , MD 2109 3 410-821-6 260 Oncology Support Groups and Classes* “Us Too” Prostate Cancer Support Group Assembling the first Monday of every month, 20 to 30 participants meet from 7:00 - 9:00 p.m., discussing educational topics and personal experiences. Facilitator: Michele Better, LCSW-C. For more information call 443-849-2961. Registration required. Look Good, Feel Better¨ Sponsored by the American Cancer Society, this program helps women undergoing cancer treatments cope with the appearance-related side effects of rehabilitation therapies, such as hair loss and changes in complexion. Meetings are held the first and third Monday of every month from 2:00 - 4:00 p.m. Facilitated by Laura Chase, Community Outreach Specialist. For more information call 443-849-2037. Registration required. Patient/Family Head and Neck Cancer Support Group This support group is composed of newly diagnosed and long-time survivors of head and neck cancer. Meeting the third Tuesday of every month from 7:00 - 8:30 p.m., participants share feelings associated with their diagnosis. Facilitators: Dorothy Gold, LCSW-C; Karen Ulmer, RN, MS, CORLN. For more information call 443-849-2087. Laryngectomee Interest Group This group provides news and information relevant to people who have had a laryngectomy. Participants also have the opportunity to share their experiences and practice voicing. Meetings are on the first Tuesday of every month from 12:00 - 1:00 p.m. Facilitators: Barbara Messing, MA, CCC-SLP, BRS-S and Melissa Walker, MS, CCC-SLP. For more information call 443-849-2087. * There is no charge for any of the above listed support groups and classes. Non-Profit Org U.S. Postage 6701 N. Charles Street Baltimore, MD 21204 PAID Permit No. 4406 Baltimore, MD