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 2 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 3 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 bwhteleservices@partners.org. 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). 4 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 5 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 bwhteleservices@partners.org. 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 7 NONPROFIT ORGANIZATION U.S. POSTAGE PAID BROCKTON, MA Permit No. 497 75 Francis Street Boston, MA 02115 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, esteward@partners.org, 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