PHYSICIAN NEWS O C T O B E R 2...

PHYSICIAN NEWS
OCTOBER 2009
PAGE 2
Specialists Provide Personalized,
Gender-specific Care for Women with Lung Cancer
The Women’s Lung Cancer Program at Dana-Farber/Brigham and
Women’s Cancer Center – part of the Thoracic Oncology Program –
is dedicated to advancing care and improving outcomes for patients
with lung cancer.
PAGE 3
New Program Delivers Specialized Cardiovascular
Care for Cancer Patients
Specially-trained cardiologists in the Cardio-Oncology Program deliver
care for cancer patients with pre-existing cardiovascular conditions and
patients who develop cardiac complications from cancer treatment.
Confocal Laser Endomicroscopy Imaging Enhances
PAGE 4
Detection of Neoplasia and Dysplasia in the
Gastrointestinal Tract
The Endoscopy Center is offering a new and revolutionary laser
endomicroscopy imaging technology that enables specialists to visualize
the lining of the gastrointestinal tract at a cellular level.
PAGE 5
Expanded Services at Brigham and Women’s/
Mass General Health Care Center in Foxborough
Brigham and Women’s/Mass General Health Care Center has recently
added gastroenterology, neurosurgery consultation, pulmonology, renal
medicine, reproductive endocrinology, and urology services to its range
of medical, surgical, and diagnostic services.
New Center Offers Expert Cancer Services in
PAGE 6
Southeastern Massachusetts
Located in South Weymouth, the new Dana-Farber/Brigham and
Women’s Cancer Center in clinical affiliation with South Shore
Hospital provides expert, comprehensive, community-based cancer care.
Continuing Medical Education
PAGE 7
1-800-MD-TO-BWH • www.brighamandwomens.org
Specialists Provide Personalized, Gender-specific Care
for Women with Lung Cancer
The Women’s Lung Cancer Program at Dana-Farber/Brigham and Women’s Cancer Center – part of the
Thoracic Oncology Program – offers expert multidisciplinary evaluation, care, and support for patients with
lung cancer.
The Women’s Lung Cancer Program, directed by Yolonda
L. Colson, MD, PhD, is dedicated to understanding the
significance of gender in lung cancer susceptibility, tumor
biology, and disease course in order to develop the most
effective, personalized treatment plan for each patient.
The Program is currently leading several promising
research studies, including:
Program specialists are evaluating specific genetic
mutations in tumors, as well as the greater susceptibility
of women to develop certain types of lung cancer, such as
bronchoalveolar carcinoma (BAC) and adenocarcinoma.
• Characterization of micrometastatic nodal disease in
lung cancer – This NCI-funded Phase I/II clinical
trial is exploring the clinical application of an
optical imaging technology that uses safe, invisible,
near-infrared (NIR) fluorescent light to permit sentinel
lymph node (SLN) identification via real-time image
guidance during surgery.
In addition, Program specialists are examining the basis
for the development of lung cancer in women who have
never smoked (accounting for 20 percent of all women
with lung cancer, compared with only five to 10 percent
of male lung cancer patients).
NIR fluorescent lymphotrophic contrast agents permit
non-radioactive, real-time lymphatic mapping that will
provide a clinically applicable means to improve
surgical staging with expected therapeutic benefit to
patients with early-stage lung cancer;
Program experts also are evaluating ways to reduce the
high recurrence rates of early lung cancer among women
– as high at 40 percent with an average 60 percent
survival rate. The Program is dedicated to advancing the
understanding and identification of lung cancer as a
women’s cancer – accounting for more deaths among
women each year than breast, ovarian, and uterine
cancers combined.
• Design and validation of drug-eluting polymers for
peri-operative loco-regional drug delivery – These
pre-clinical studies examine numerous polymer and
nanoparticle drug delivery mechanisms aimed at
preventing cancer recurrence at either the suture line or
within regional lymph nodes following surgery.
Providing highly specialized diagnosis and treatment for
women diagnosed with lung cancer, specialists in the
Program use:
• Sub-specialized radiologic and pathology tools;
• Expert surgical intervention;
• Advanced medical and adjuvant therapies;
• Cutting-edge translational research;
• Comprehensive support services.
Through thoracic surgeons, oncologists, pulmonologists,
social workers, and other specialists, the Program offers
the latest in clinical trials, minimally invasive surgical
techniques, and oncology therapies designed to
improve outcomes.
Copolymer films containing paclitaxel are being
evaluated to prevent growth of recurrent disease
following resection of primary tumor nodules. Polymer
nanoparticles with ph-sensitive intracellular drug release
mechanisms have been shown to migrate through
lymphatic channels to deliver chemotherapy to regional
lymph nodes.
continued on page 7
Indications for Referral
The Women’s Lung Cancer Program evaluates and
treats patients who have been diagnosed with lung
cancer and would benefit from a detailed, genderspecific approach to care.
1-800-MD-TO-BWH
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New Program Delivers Specialized Cardiovascular Care
for Cancer Patients
One of few of its kind in the country, the Cardio-Oncology Program offers care for cancer patients with
pre-existing cardiovascular conditions and those who develop cardiac complications from cancer treatment.
Led by Anju Nohria, MD, a cardiologist with special
training in epidemiology and heart failure, and Javid
Moslehi, MD, a cardiologist with additional training in
molecular oncology, the Cardio-Oncology Program – a
joint initiative between the Division of Cardiovascular
Medicine at Brigham and Women’s Hospital and DanaFarber/Brigham and Women’s Cancer Center – strives to
minimize cardiotoxicity during cancer treatment and
cardiovascular risks during cancer survival. Patients are
seen at the Watkins Cardiovascular Clinic located at the
Carl J. and Ruth Shapiro Cardiovascular Center at
Brigham and Women’s Hospital and at the
Lance Armstrong Foundation Clinic at Dana-Farber
Cancer Institute.
The Program offers specialized care for cancer patients
with pre-existing cardiovascular conditions and the
roughly 30 percent of cancer patients who develop
cardiac complications from cancer treatment, including
therapies with cardiovascular sequalae that both impede
continued treatment and cause short- and long-term
morbidity or mortality. Strategies used by specialists in
the Program include:
• The use of cardioprotective medications, including
beta blockers and ACE inhibitors, prior to the
commencement of cancer treatment;
• Collaboration with medical oncologists to adjust
dose or timing of cancer therapies;
• Evaluation of alternative cancer therapies with less
cardiotoxic effects.
The above strategies have proven beneficial for patients
diagnosed with cancer types that are most effectively
treated with therapies that are known to contribute to
cardiovascular conditions, such as cardiomyopathy. By
A 42-year-old patient with breast
cancer started treatment with
Herceptin, however, a routine
echocardiogram (left) showed a
slightly dilated left ventricle with
moderate cardic dysfunction. Due to
Herceptin’s risk of cardiotoxicity, the
treatment was stopped. Cardiologists
in the Cardio-Oncology Program
worked with the patient’s oncologist
to resume use of Herceptin, while treating her with cardioprotective
medications. The patient’s cardiac function has returned to near
normal levels.
beginning cardioprotective measures prior to the start of
cancer treatment and closely monitoring or adjusting dose
and timing, patients who may not have been eligible for
certain cancer medications due to pre-existing
cardiovascular conditions are able to benefit from the most
appropriate cancer therapies.
Traditional cancer treatments associated with cardiac
dysfunction include anthracyclines, radiation therapy, and
newer agents, such as Herceptin. Specialists in the Program
also are evaluating ways to prevent potential cardiovascular
complications, such arrhythmias, cardiomyopathy,
cardiac ischemia, and hypertension, resulting from
certain novel molecular targeted therapies, including
angiogenesis inhibitors.
Access and Information
For more information, or to refer a patient,
please call the Watkins Cardiovascular Clinic at
(857) 307- 4000 or the Lance Armstrong Foundation
Clinic at (617) 632- 4LAF (4523).
Anju Nohria, MD
Co-director, Cardio-Oncology Program
Indications for Referral
The Cardio-Oncology Program provides care for
patients with:
• Cardiovascular history who need to undergo cancer
treatment (both medical and surgical treatments);
• Heart failure following cancer treatment.
Javid Moslehi, MD
Co-director, Cardio-Oncology Program
www.brighamandwomens.org
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Confocal Laser Endomicroscopy Imaging Enhances
Detection of Neoplasia and Dysplasia in the
Gastrointestinal Tract
Specialists in the Endoscopy Center at Brigham and Women’s Hospital are among few nationwide and a handful
in New England to offer a new confocal endomicroscopy technology that enhances diagnosis by detecting early
changes at a cellular level.
The Endoscopy Center is offering a new and
revolutionary endomicroscopy technology designed to
help detect changes at a microscopic level. One of the first
10 sites in the nation to evaluate this technology, which
was recently approved by the FDA, Brigham and
Women’s Hospital also is one of few in New England to
offer it.
Benefits of this technology include the ability to:
Used for both upper and lower gastrointestinal
evaluation, the confocal endoscopy device is a probe
passed through the channel of an endoscope that enables
specialists to visualize the lining of the gastrointestinal
tract at a cellular level – offering a much more detailed
view of the tissue than provided with the magnification of
a standard endoscope.
• Obtain additional diagnostic information regarding
abnormal tissue and provide a basis to proceed with
more targeted or specific therapy;
Confocal endomicroscopy imaging is useful in evaluating
patients with esophageal disorders – including Barrett’s
esophagus – gastric lesions, and determining the cause of
bile duct narrowing. It also has been used to help
to characterize and define the margins for resection of
colonic polyps.
Figure 1
Figure 2
• Characterize mucosa at the cellular level in real time
during endoscopy;
• Distinguish normal and abnormal cells with
more precision than is capable with a
standard endoscope;
• Better target areas for biopsy and identify margins
for removal of dysplastic tissue;
• Confirm clean margins after tissue removal.
Indications for Referral
The Endoscopy Center provides screening and
treatment for the full range of gastrointestinal tract
conditions, and physicians in the Center collaborate
closely with other Brigham and Women’s Hospital
gastroenterologists, general surgeons, and other
specialists in the care of patients with more
complex conditions.
Information and Referrals
For more information regarding the Endoscopy
Center, or to refer a patient, please contact our
Referral Coordinators at (617) 732-9894
or [email protected].
John R. Saltzman, MD
Director of Endoscopy
Figure 3
Figure 4
Normal colonic mucosa (Figures 1 and 2) and colonic
adenoma (Figures 3 and 4) are compared using confocal laser
endomicroscopy imaging (Figures 1 and 3) and histopathology
(Figures 2 and 4).
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David L. Carr-Locke, MD, FRCP, FACGE
Director, Endoscopy Research and Education
1-800-MD-TO-BWH
Expanded Services at Brigham and Women’s/
Mass General Health Care Center in Foxborough
Located next to Gillette Stadium in Foxborough, Massachusetts, the Brigham and Women’s/Mass General Health
Care Center is expanding its variety of medical, surgical, and diagnostic services.
• Renal Medicine – Comprehensive care in the treatment
of kidney-related diagnoses, including hypertension,
inherited kidney diseases, kidney stones, nephritis,
vasculitis and kidney failure;
Part of Patriot Place in Foxborough, Massachusetts, the
Brigham and Women’s/Mass General Health Care Center
opened in February 2009.
Brigham and Women’s/Mass General Health Care Center
is a state-of-the-art outpatient and day surgery facility
offering convenience and quality care provided by
Brigham and Women’s Hospital and Massachusetts
General Hospital physicians practicing at the Center.
New services at the Center include:
• Gastroenterology – Services for adult and adolescent
patients with disorders of the gastro-intestinal tract,
pancreas, biliary tree and liver. Specialists provide
care for pancreatic disease, biliary disease, liver
disease, inflammatory bowel disease and GI
oncology evaluation.
• Neurosurgery Consultation – Multidisciplinary
evaluation and complete management of pre-surgical
and post-operative care for neurosurgical conditions,
including benign and malignant brain tumors,
cerebrovascular disease, movement disorders and
epilepsy, vascular abnormalities, degenerative spine
disease, and other related brain and spinal disorders.
• Reproductive Endocrinology – Reproductive specialists
offer fertility consultation, evaluation, and surgical
procedures to address the full range of reproductive
barriers. Specialists provide ambulatory appointments
associated with ovulation induction; therapeutic donor
insemination; assisted reproductive technologies,
including in vitro fertilization (IVF), intracytoplasmic
sperm injection (ICSI), testicular biopsy/sperm
freezing, cryopreservation of sperm and embryos, and
preimplantation genetic diagnosis (PGD); minimally
invasive surgery; advanced non-surgical therapies for
uterine fibroids and endometriosis; fertility therapy for
cancer patients and survivors; evaluation and treatment
of recurrent pregnancy loss; and pre-conception genetic
testing and diagnosis;
• Urology – Diagnosis, treatment, and management for
urologic conditions. Services include diagnostic
cystoscopy, retrograde pyelogram, transurethral
resection of bladder tumor, cold knife urethrotomy,
bladder stone removal, fulgeration of bladder tumors,
bladder biopsy, ureteroscopy, installation of
chemo/formalin, laser lithotripsy for kidney stone cases;
EHL; urethral or bladder neck contracture dilation;
circumcision; s/p tube change; ureteral stent placement
and removal; prostate needle biopsy, varicocelectomy,
hyrocelectomy, vasectomy, testicular biopsy,
orchiectomy, and SPARC procedures.
Information and Referrals
To refer a patient to the Brigham and Women’s/
Mass General Health Care Center, or for more
information, please call (866) 378-9164 or visit
brighamandwomens.org/foxborough.
• Pulmonology – Services span the entire spectrum of
respiratory diseases and disorders, including treatment
of COPD, ILD, LAM, CSS, and asthma;
www.brighamandwomens.org
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New Center Offers Expert Cancer Services in
Southeastern Massachusetts
• Research and Clinical Trials, including access to
clinical trials through Dana-Farber/Harvard
Cancer Center;
• Imaging Services, including computed tomography
(CT), magnetic resonance imaging (MRI), positron
emission tomography combined with CT (PET/CT),
and digital mammography;
• Breast Care Center, including comprehensive care for
patients with benign or malignant breast conditions;
• Integrative Therapies, including acupuncture
and massage;
Dana-Farber/Brigham and Women’s Cancer Center in clinical
affiliation with South Shore Hospital offers expert, communitybased cancer care. Other community locations include DanaFarber/Brigham and Women’s Cancer Center at Faulkner
Hospital and Dana-Farber/Brigham and Women’s Cancer Center
at Milford Regional Medical Center.
The new Dana-Farber/Brigham and Women’s Cancer
Center in clinical affiliation with South Shore Hospital
offers expert, community-based cancer care through
collaboration among specialists at Brigham and Women’s
Hospital, Dana-Farber Cancer Institute, South Shore
Hospital, and Harbor Medical Associates.
Located at South Shore Hospital in South Weymouth,
Massachusetts, the new Center offers advanced
services, including:
• Medical Oncology and Infusion, including a
pharmacy with advanced technologies, such as a
computerized ordering system and bar-coded
medications, to enhance patient safety;
• Multispeciality Services/Surgical Oncology and
Consultation, including specialists in breast,
gastrointestinal, genitourinary, gynecologic, plastic,
and thoracic surgery; neurosurgery; and
otolaryngology;
• Additional Services, including nutrition, patient
education and educational resources, social work,
support groups, and pastoral care.
Thomas E. Clancy, MD
Medical Director,
Multidisciplinary Surgical Oncology
Rolf Freter, MD, PhD
Medical Director,
Medical Oncology
Russell Kelley, MD
Medical Director,
Diagnostic Imaging Services
Tatiana Lingos, MD
Medical Director,
Radiation Oncology
Suniti Nimbkar, MD
Medical Director,
Breast Care Center
• Radiation Oncology, including image-guided
radiation therapy and intensity-modulated
radiation therapy;
1-800-MD-TO-BWH
6
Specialists Provide Personalized, Gender-specific Care for Women with Lung
Cancer… continued from page 2
Patient Support
The Program offers the Women’s Lung Cancer Forum, a
monthly meeting for patients with lung cancer and their
family members, held in Chestnut Hill, Massachusetts.
Designed to provide a supportive environment for
patients to learn about lung cancer and become advocates
for lung cancer care, surrounded by fellow survivors of
lung cancer, the Forum offers seminars on a wide range of
topics, presented by medical professionals, advocates and
cancer survivors.
Information and Referrals
For more information regarding the Women’s Lung
Cancer Program, or to refer a patient, please contact
our Referral Coordinators at 1-877-332-4294
or email [email protected].
Yolonda L. Colson, MD, PhD
Director, Women’s Lung Cancer Program
The Forum is held on the second Wednesday of every
month at 6:30 p.m. at the Gretchen S. and Edward A.
Fish Center for Women’s Health at the Brigham and
Women’s Ambulatory Care Center, 850 Boylston Street,
4th Floor, Chestnut Hill, Massachusetts. Attendance is
open and does not require registration.
Continuing Medical Education
Brigham and Women’s Hospital is pleased to offer the following courses, occurring in November
and December 2009, through the Harvard Medical School Department of Continuing Education. Please call
(617) 384-8600 or visit www.med.harvard.edu/conted for more information.
November
December
November 9-12
Electromyography and Neuromuscular Medicine
Location:
Omni Parker House,
60 School Street, Boston, MA
Directors:
Anthony Amato, MD;
William S. David, MD PhD; Peter Siao, MD
Offered by: Brigham and Women’s Hospital,
Department of Neurology;
Massachusetts General Hospital,
Department of Neurology
November 21-22
Interpreting the Endometrial Biopsy:
A Hands On Microscopic Tutorial
Location:
Brigham and Women’s Hospital,
75 Francis Street, 3rd Floor, Boston, MA
Director:
George L. Mutter, MD
Offered by: Brigham and Women’s Hospital,
Department of Pathology
December 7-8
17th Annual Tumors of the Central Nervous System:
Brain Tumor Management
Location:
Mandarin Oriental,
776 Boylston Street, Boston, MA 02116
Directors:
Peter M. Black, MD, PhD; Jay S. Loeffler, MD
Offered by: Brigham and Women’s Hospital,
Department of Neurosurgery;
Children’s Hospital, Department of Neurosurgery;
Massachusetts General Hospital,
Department of Radiation Oncology;
Dana-Farber/Harvard Cancer Center;
Brain Science Foundation
Department of Continuing eDuCation
www.brighamandwomens.org
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PHYSICIAN NEWS
Innovative approaches for women with lung cancer, cardiotoxicity
reduction in cancer treatment, and endomicroscopic evaluation
of the gastrointestinal tract inside this issue.
Access to
Brigham and Women’s Hospital
The Carl J. and Ruth Shapiro Cardiovascular Center
Physician Referral Service
1-800-MD-TO-BWH (1-800-638-6294)
Experienced referral coordinators assist with outpatient
appointments, access to our physicians, and information
regarding our specialists and services.
Physician Liaison
Physician Liaison Ellen Steward provides direct
assistance with patient referrals and consultations with
our specialists. Ellen is available to meet with you
in person and can be reached at (617) 732-9598,
[email protected], or pager (617) 732-5700,
ID #36031.
MD Connect
(Inpatient Transfers and Transportation Services)
1-877-637-3337
Care Coordination
(Facilitation of Care Plan and Discharge Planning)
(617) 732-6469
Cardiovascular Access Managers
Cardiovascular Access Managers Lisa Downey, RN, BSN,
and Brian Laneau, RN, BSN, assist with inpatient transfers
and consultations with our team of cardiovascular experts.
They can be reached at (617) 543-4170.
Watkins Cardiovascular Clinic
(857) 307-4000