St. Francis Cancer Treatment Center

Oncology Update10I S S U E

A P R2 0 1 5

Dr. Dron Gauchan • Dr. Doug Clark Dr. M. Sitki Copur • Dr. Ryan Ramaekers

B r i n g i n g t h e b e s t c a n c e r c a r e t o y o u r c o m m u n i t i e s

in this issue• St. Francis taking part in CHI Lung

Centers of Excellence (LCOE) project

• St. Francis hosts preview of NET cancer documentary

• Lynch Syndrome and colon cancer

Cancer Treatment Center continues to excel in clinical research activitySt. Francis Cancer Treatment Center is on its way to another high performance year in its clinical trials endeavor. With the National Community Oncology Research Program (NCORP) grant awarded in August 2014, our clinical trial research activity has increased substantially. The number of available National Cancer Institute (NCI)-sponsored clinical trials has now reached a total of 31. There are another 25 NCI-sponsored clinical trials in the process of being activated through CHI-NCORP which will be available to our patient population soon.

A comprehensive clinical trials web site has been designed and is available at http://chinebraskaclinicaltrials.org/. By visiting this site referring physicians and patients can easily search and access available clinical trials at our center. Trials are searchable by clinical trial name, anatomic tumor site, institution name/location, or any combination of those criteria. It also includes available trials at Good Samaritan Cancer Center in Kearney, St. Elizabeth Cancer Institute, and

Nebraska Cancer Research Center in Lincoln.

Thanks to our dedicated cancer team, referring physicians and most importantly to our patients, St. Francis has thus far held the highest accrual rate for clinical trials among all CHI-NCORP sites. Through NCORP and the CHI-Oncology Research Alliance (CORA), St. Francis Cancer Treatment Center is proud to provide access to high-priority National Cancer Institute trials for the rural central Nebraska population. v

Tumor Site Number of Available Trials

Breast 9CLL 2Colon 1Esophageal 1Head & Neck 1Liver 1Lung 6MDS 1Melanoma 1Multiple Myeloma 2Ovarian 1Pancreas 1Prostate 1Registry 2Renal 1

Open trials at St. Francis Cancer Treatment Center

Catholic Health Initiatives has laid the groundwork for the creation of a national Lung Centers of Excellence (LCOE) model for defining and developing high quality, high value comprehensive lung cancer care programs across the CHI enterprise. The ultimate goal is to ensure that all lung cancer patients treated at any CHI facility consistently receive evidence-based, high quality and high value care.

CHI already has a well-defined Breast Centers of Excellence (BCOE) program, which involves certifications in three different areas through three different national governing bodies – Quality, through the National Quality Measures for Breast Centers (NQMBC); Imaging, through the American College of Radiology (ACR); and Structure, through the National Accreditation Program for Breast Centers (NAPBC). By accomplishing this landmark achievement of BCOE, the St. Francis Cancer Treatment Center is among the top one percent of breast centers in the country documenting performance.

Unlike the Breast Centers of Excellence, the framework and pillars of the Lung Centers of Excellence certification have not yet been clearly defined. Rather, this is an innovative work in progress through the collaboration of several CHI-network sites. The proposed model is evaluating a spectrum of measures based on and around the key quality program requirements ranging from prevention (smoking cessation), screening (low dose chest CT), genetic/molecular pathology testing, to interventional pulmonology, interventional radiology, minimally invasive surgery, stereotactic beam radiation therapy, and palliative care.

St. Francis Cancer Treatment Center, along with other CHI network sites, is actively taking part in this new exciting venture. Our team currently includes pulmologist Dr. Salam Salman, radiologist Dr. Max Stevens, interventional radiologist Dr. Cody Evans, oncologist Dr. M. Sitki Copur and pathologist Dr. Kris Mleczko. Please contact Dr. Copur at (308) 398-5450 if you are interested in learning more and/or becoming a part of this developing project. v

St. Francis taking part in CHI Lung Centers of Excellence (LCOE) project

Role of Magnetic Resonance Imaging in the Management of Patients with Multiple Myeloma:A Consensus Statement

International Myeloma Working Group worked on developing practical recommendations for the use of magnetic

resonance imaging (MRI) in multiple myeloma (MM) patients and published their consensus statement in Journal of Clinical Oncology in February 2015. An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations for the value of MRI based on data published through March 2014. MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells compared with other radiographic methods. Thus, MRI detects bone involvement in patients with myeloma much earlier than the myeloma-related bone destruction, with no radiation exposure. It is the gold standard for the imaging of axial skeleton, for the evaluation of painful lesions, and for distinguishing benign versus malignant osteoporotic vertebral fractures. MRI has the ability to detect spinal

cord or nerve compression and presence of soft tissue masses, and it is recommended for the workup of solitary bone plasmacytoma. Regarding smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not available), and if they have more than one focal lesion of a diameter of more than 5 mm, they should be considered to have symptomatic disease that requires therapy. In cases of equivocal small lesions, a second MRI should be performed after 3 to 6 months, and if there is progression on MRI, the patient should be treated as having symptomatic myeloma. MRI at diagnosis of symptomatic patients and after treatment (mainly after autologous stem-cell transplantation) provides prognostic information; however, until this publication it has not changed treatment selection.

Reference: Meletios A. Dimopoulos, et al Role of Magnetic Resonance Imaging in the Management of Patients with Multiple Myeloma: A Consensus Statement. J Clin Oncol 2015; 33:657-664.

Potentially PracticeChanging Data

A Prospective Randomized Trial for Good-Risk Ductal Carcinoma in Situ Comparing Radiotherapy with Observation-RTOG-9804

The Radiation Therapy Oncology Group 9804 study identified good-

risk patients with ductal carcinoma in situ (DCIS), a breast cancer diagnosis found frequently in mammographically detected cancers, to test the benefit of radiotherapy (RT) after breast-conserving surgery com-pared with observation. This prospective randomized trial (1998 to 2006) in women with mammographically detected low or in-termediate-grade DCIS, measuring less than 2.5 cm with margins more than3 mm, com-pared RT with observation after surgery. The study was designed for 1,790 patients but was closed early because of lower than projected accrual. Six hundred thirty-six patients from the United States and Cana-da were entered; tamoxifen use (62%) was optional. Ipsilateral local failure (LF) was the primary end point; LF and contralateral failure were estimated using cumulative incidence, and overall and disease-free sur-vival was estimated using the Kaplan-Meier method. Median follow-up time was 7.17 years (range, 0.01 to 11.33 years). Two LFs occurred in the RT arm, and 19 occurred in the observation arm. At 7 years, the LF rate was 0.9% (95% CI, 0.0% to 2.2%) in the RT arm versus 6.7% (95% CI, 3.2% to 9.6%) in the observation arm (hazard ratio, 0.11; 95% CI, 0.03 to 0.47; P _ .001). Grade 1 to 2 acute toxicities occurred in 30% and 76% of patients in the observation and RT arms, respectively; grade 3 or 4 toxicities occurred in 4.0% and 4.2% of patients, respectively. Late RT toxicity was grade 1 in 30%, grade 2 in 4.6%, and grade 3 in 0.7% of patients. In this good-risk subset of patients with DCIS, with a median follow-up of 7 years, the LF rate was low with observation but was decreased significantly with the addition of RT. Longer follow-up is planned because the timeline for LF in this setting seems protracted.

Reference: Cuzick J , Sestak I, Cawthorn S et al. Lancet Oncology 2014; http://dx.doi.org/10.1016/51470-20459(14)71171-4.

Potentially PracticeChanging Data

CHI Health St. Francis, in conjunction with NET Television, hosted a preview screening of Cancer: The Emperor of All Maladies, a Barak Goodman film presented by Ken Burns.

Cancer: The Emperor of All Maladies is a three-part documentary based on the Pulitzer Prize-winning book by Siddhartha Mukherjee. The documentary which aired March 30, 31 and April 1 on NET, Nebraska’s PBS station, analyses and reports different aspects of this complicated illness with a cellular biologist’s precision, a historian’s perspective and a biographer’s passion.

The documentary screening was followed by a panel discussion on topics related to a community approach to cancer care. The panel was moderated by Shaun Schleif, the director of marketing and sponsorships for the Nebraska State Fair. Panelists included Dr. M. Sitki Copur, medical director of oncology at St. Francis Cancer Treatment Center; Marilyn Kile, APRN, a nurse practitioner at Good Samaritan Cancer Center in Kearney; Jill Koch, the American Cancer Society primary account manager for Commission On Cancer accredited hospitals in Nebraska and Northern Kansas; and Lisa Willman, co-founder of the GRACE Foundation and breast cancer survivor.

The panelists shared their expertise on issues such as funding the high cost of cancer care, strides being made in the clinical research arena, the importance of addressing not only the cancer patient’s physical and emotional needs but those of the family as well. Another highlight of the discussions was the availability of community-based oncology research and cutting-edge cancer care delivery right here at central Nebraska which were made possible thanks to our National Community Oncology Research Program (NCORP) grant and our affiliations with CHI-Institute for Research and Innovation (CIRI) and National Cancer Institute (NCI) designated Eppley Cancer Center. v

St. Francis hosts preview of NET cancer documentary

Event panelists Dr. M. Sitki Copur, Lisa Willman, Jill Koch and Marilyn Kile, APRN.

Physician Spotlight Eigenberg joins Surgery Group of Grand IslandSt. Francis would like to welcome Dr. Michael Eigenberg to the Surgery Group of Grand Island. Dr.

Eigenberg joined the staff on March 16, becoming the most recent addition to the St.Francis Cancer Treatment Center’s multidisciplinary cancer team..

He completed his medical education from the University of Nebraska College of Medicine in 2008 and completed a general surgery residency from Michigan State University in 2013. Prior to joining St. Francis Dr. Eigenberg practiced at Sparrow Hospital in Lansing, MI, and had an academic teaching appointment with Michigan State University.

Gauchan receives board certificationsCongratulations to Dr. Dron Gauchan of St. Francis Cancer Treatment Center

on passing his boards in December 2014! He is now board certified in medical oncology and hematology. Dr. Gauchan joined the Cancer Treatment Center staff

in July 2014 after completing his hematology and oncology fellowship at Seton Hall University in South Orange, NJ.

Omel featured in Patient Power videoDr. Jim Omel was recently featured in a Patient Power video debunking medical myths. In the first video of the series, myeloma expert Dr. Paul Richardson from Dana Faber Cancer Institute in Boston visits with Omel about the common misconceptions of clinical trials.

“Myeloma Myth Busters: Clinical Trials” covers such topics as the fear that the patient will be a “guinea pig,” that they will receive a placebo, and that trials are the last resort or only for people who have run out of options. Richardson and Omel

highlight the fact that clinical trials are the best oncology care, and that patients are carefully monitored throughout their treatment.

To view the video, “Myeloma Myth Busters: Clinical Trials,” please visit http://www.patientpower.info/video/myeloma-myth-busters-clinical-trials

The abstract “Cancer Genetic Counseling Services (GCS) at St. Francis Cancer Treatment Center (SFCTC)” has been accepted for publication at the 2015 ASCO Annual Meeting, which will take place May 29 – June 2 at the McCormick Place Convention Center in Chicago. Over 5,900 abstracts were submitted for review by the Scientific Program Committee and ASCO Leadership.

This abstract analyzed six years of GCS data at St. Francis, including medical/family history, genetic counseling referral source/rate, refusal/failure to show, risk assessment/management, genetic tests offered/performed, and genetic syndromes suspected/confirmed. The study concluded that the availability of genetic counseling services enhanced its utilization and highlighted the need for awareness and education of these services.

Contributors to this abstract include: Mehmet Sitki Copur, Kimberly Brussow, Jack Wagoner, Ryan C. Ramaekers, Mithat Gonen, Stephanie Percich, Dron Gauchan, Lata Nawal, Mary Mickey, Max Norvell, Douglas Clark, K. M Islam; St. Francis Cancer Treatment Center, Grand Island, NE; University of Nebraska Medical Center, Omaha, NE; Memorial Sloan Kettering Cancer Center, New York, NY.

St. Francis abstract accepted for publication

Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

An update committee reviewed the identified abstracts to provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer and published their recommendations in February 2015 issue of Journal of Clinical Oncology. PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. Most hospitalized patients with active

cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications. Patients with cancer should be periodically assessed for VTE. Reference: Gary H. Lyman,et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014. J Clin Oncol 33:654-656.

Potentially PracticeChanging Data

Ruxolitinib versus Standard Therapy for the Treatment of Polycythemia Vera

Ruxolitinib, a Janus kinase (JAK) 1 and 2 inhibitor, was shown to have a clinical benefit in patients with polycythemia vera in a phase 2 study.A phase 3 open-

label study to evaluate the efficacy and safety of ruxolitinib versus standard therapy in patients with polycythemia vera who had an inadequate response to or had unacceptable side effects from hydroxyurea was published in January 2015 issue of New England Journal of Medicine. Two hundred and thirty-two phlebotomy-dependent polycythemia vera patients with splenomegaly were randomly assigned, in a 1:1 ratio, to receive ruxolitinib (110 patients) or standard therapy (112 patients). The primary end point was both hematocrit control through week 32 and at least a 35% reduction in spleen volume at week 32, as assessed by means of imaging. The primary end point was achieved in 21% of the patients in the ruxolitinib group versus 1% of those in the standard-therapy group (P<0.001). Hematocrit control was achieved in 60% of patients receiving ruxolitinib and 20% of those receiving standard therapy; 38% and 1% of patients in the two groups, respectively, had at least

a 35% reduction in spleen volume. A complete hematologic remission was achieved in 24% of patients in the ruxolitinib group and 9% of those in the standard-therapy group (P = 0.003); 49% versus 5% had at least a 50% reduction in the total symptom score at week 32. In the ruxolitinib group, grade 3 or 4 anemia occurred in 2% of patients, and grade 3 or 4 thrombocytopenia occurred in 5%; the corresponding percentages in the standard-therapy group were 0% and 4%. Herpes zoster infection was reported in 6% of patients in the ruxolitinib group and 0% of those in the standard- therapy group (grade 1 or 2 in all cases). Thromboembolic events occurred in one patient receiving ruxolitinib and in six patients receiving standard therapy. In patients who had an inadequate response to or had unacceptable side effects from hydroxyurea, ruxolitinib was superior to standard therapy in controlling the hematocrit, reducing the spleen volume, and improving symptoms associated with polycythemia vera. Based on this study, FDA approved Ruxolitinib for Polycythemia Vera

Reference: Alessandro M. Vannucchi et al. Ruxolitinib versus Standard Therapy for the Treatment of Polycythemia Vera N Engl J Med 2015; 372:426-435.

Potentially PracticeChanging Data

Lynch Syndrome and colon cancerOverviewLynch syndrome (formerly called Hereditary Non-Polyposis Colon Cancer syndrome or HNPCC) is a genetic condition that increases the risk of developing early onset colorectal cancer and other cancers including endometrial, ovarian, stomach, small bowel and brain. Lynch syndrome can be due to a mutation of either the MLH1, MSH2, MSH6, or PMS2 genes. Approximately 5% of all colon cancers may be due to Lynch syndrome.

Genetics and Inheritance of Lynch Syndrome Lynch syndrome is caused by a mutation in one of four known genes called MLH1, MSH2, MSH6, or PMS2. When a gene’s code contains a mutation, the normal cell function is impaired or changed. Thus in some instances gene mutations can lead to disease. Each person has two copies of every gene, one copy from their mother, and one copy is inherited from their father. A mutation in a single copy of the MLH1, MSH2, MSH6, or PMS2 genes leads to the increased risk of cancer as seen in Lynch syndrome.

Lynch syndrome can be passed down through the family by both men and women; there is a 50% (1 in 2) chance that a person with Lynch syndrome will pass the mutation in the affected gene to each of their children. This is called autosomal dominant inheritance.

Genetic testing is available to help identify whether an individual has Lynch syndrome. Because Lynch syndrome is associated with mutations in multiple genes, preliminary tumor testing on colorectal/endometrial tumor tissue (including microsatellite instability and immunohistochemical staining) is helpful in clarifying which genes should be further analyzed. Universal tumor screening on all newly diagnosed colon tumors is offered at many institutions across the country.

A process is currently in development at the St. Francis Cancer Treatment Center.

If a mutation is eventually found in the MLH1, MSH2, MSH6, or PMS2 genes, this confirms the diagnosis of Lynch syndrome and allows other at-risk relatives to be tested for the specific mutation. Sometimes genetic testing will not find a mutation in the MLH1, MSH2, MSH6, or PMS2 genes in someone with features suggestive of Lynch syndrome. This may be explained by limitations in current technology (the person may still carry an undetectable mutation) or another gene may be responsible for the cancer in the family. A genetics professional can help determine if genetic testing for other genes is warranted.

Medical Management For individuals with Lynch syndrome, specialized cancer prevention and early detection guidelines are available to address the increased cancer risks. These interventions can include a range of recommendations and options, such as regular screening, preventive surgery and certain medications.

When to consider evaluation for Lynch syndromeFeatures in the family history which may suggest Lynch syndrome:• Family member with a confirmed diagnosis of Lynch

syndrome• Colon cancer diagnosed before age 50• Any Lynch syndrome associated cancer diagnosed

before age 50*• Two separate Lynch syndrome associated cancers in

the same person*• A family history of Lynch syndrome associated

cancers in three or more family members**Lynch syndrome associated cancers are colon, endometrial, ovarian, stomach, urinary tract, hepatobiliary tract, small intestine, brain and sebaceous gland tumors.

Type of Cancer

General Population Risk

Lynch syndrome-associated risk

Colon 5.50% 28-75%

Endometrial 2.70% 27-60%

Gastric <1% 5-6%

Ovarian 1.60% 6-12%

Urinary tract <1% 8-9%

Small increased risk for small bowel, brain/central nervous system, hepatobiliary tract, skin cancer (sebaceous carcinoma, keratoacanthomas)

Genetic counselor Kim Brussow works with patient Lois Hansen

Continued on back page

Olaparib Monotherapy in Patients with Advanced Cancer and a Germline BRCA1/2 Mutation

Olaparib is an oral poly (ADP-ribose) polymerase inhibitor with activity in germline BRCA1 and BRCA2 (BRCA1/2) –associated breast and ovarian cancers. Efficacy and safety of olaparib in a spectrum of BRCA1/2-associated cancers were evaluated in a study published in Journal of Clinical Oncology in January 2015. This multicenter phase II study enrolled individuals with a germline BRCA1/2 mutation and recurrent cancer.

Eligibility included ovarian cancer resistant to prior platinum; breast cancer with more than three chemotherapy regimens for metastatic disease; pancreatic cancer with prior gemcitabine treatment; or prostate cancer with progression on hormonal and one systemic therapy. Olaparib was administered at 400 mg twice per day. The primary efficacy end point was tumor response rate. A total of 298 patients received treatment and were evaluable. The tumor response rate was 26.2% overall and 31.1%, 12.9% , 21.7%, and 50.0% in ovarian, breast, pancreatic, and prostate cancers, respectively. Stable disease more than 8 weeks was observed in 42% of patients, including 40%, 47%, 35%, and 25% of those with ovarian, breast, pancreatic, or prostate cancer, respectively. The most common adverse events (AEs) were fatigue, nausea, and vomiting. Authors concluded that responses to olaparib were observed across different tumor types associated with germline BRCA1/2 mutations and recommended further investigation in confirmatory studies.

Reference: Bella Kaufman et al. Olaparib Monotherapy in Patients with Advanced Cancer and a Germline BRCA1/2 Mutation J Clin Oncol 2015;33:244-250.

Potentially PracticeChanging Data

FDA Hematology/Oncology Drug Approvals• Dinutuximab (Unituxin, United Therapeutics Corporation), in combination with granulocyte-macrophage

colony-stimulating factor (GM-CSF), interleukin-2 (IL-2), and 13-cis-retinoic acid (RA), for the treatment of pediatric patients with high-risk neuroblastoma who achieve at least a partial response to prior first-line multiagent, multimodality therapy, March 10, 2015.

• Filgrastim-sndz (ZARXIO Injection, Sandoz Inc.), as a biosimilar to US-licensed Neupogen for the five indications for which US-licensed Neupogen is approved, March 6, 2015.

• Nivolumab (OPDIVO, Bristol-Myers Squibb Company) for the treatment of patients with metastatic squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, March 4, 2015.

• Panobinostat (FARYDAK capsules, Novartis Pharmaceuticals) in combination with bortezomib and dexamethasone for the treatment of patients with multiple myeloma who have received at least two prior regimens, including bortezomib and an immunomodulatory agent. As a condition of this accelerated approval, FDA requires the sponsor to conduct a trial to verify and describe the clinical benefit of panobinostat for patients with multiple myeloma, February 23, 2015.

• Lenvatinib (Lenvima) for the treatment of patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer, February 13, 2015.

• FDA granted accelerated approval to Palbociclib (IBRANCE, Pfizer, Inc.) for use in combination with letrozole for the treatment of postmenopausal women with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer as initial endocrine-based therapy for their metastatic disease, February 3, 2015.

• Ibrutinib (Imbruvica Capsules, Pharmacyclics, Inc.) for the treatment of patients with waldenstrom’s macroglobulinemia (WM). Ibrutinib was initially approved in November 2013 for the treatment of patients with mantle cell lymphoma (MCL) who have received at least one prior therapy. Ibrutinib also received approval in February 2014 for the treatment of chronic lymphocytic leukemia (CLL) in patients who received at least one prior therapy and in July 2014 for the treatment of CLL with 17p deletion, January 29, 2015.

• Nivolumab (OPDIVO, Bristol-Myers Squibb Company) for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor, December 22, 2014.

C O N TAC T I N F O R M AT I O N St. Francis Cancer Treatment Center2116 West Faidley AvenueGrand Island, NE 68803(308) 398-5450http://chihealthstfrancis.org/

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Oncology Update Issue 10 April 2015

Providers:M. Sitki Copur, MD, FACP

Medical Director of OncologyRyan Ramaekers, MDDron Gauchan, MDDoug Clark, MDDeborah Nelson, APRN, AOCNPMonica McDonald, APRNJami Kezeor, APRNMegan Schriner, PA

Clinical Trials:Sarah Einspahr, RN, OCNMary Gulzow, CRA, CCRPRebecca Hadenfeldt, BSN, CCRPJennifer Scott, BSN, OCN

Center for Translational Research Alicia Wicht, CRA

Pharmacists:Angie Obermiller, PharmD

Oncology Pharmacy SupervisorJon Olsen, PharmDMark Tharnish, PharmD

Navigators:Courtney Fuller, RN, OCN

Breast Cancer Nurse NavigatorAshley Wissing, MA

Colorectal and Patient Navigator

Nutritionist:Maureen Hilderbrand, RD, LMNT

Genetic Counselor:Kim Brussow, MS, CGC

Tumor Registry:Leslie Mlinar, CTRPatty Tripp, CTR, RHIT

Pastoral Care:Rev. Jose Flores, Chaplain

Oncology Project Coordinator:Ann Tvrdy, MSN, CRNI

Certified Tobacco Cessation Facilitator

Community Outreach CoordinatorConnie Hameloth, RN

Certified Tobacco Cessation Facilitator

Management:Max Norvell, PharmD

Director of OncologyMary Mickey, RN, OCN

Clinical Manager, Medical OncologyHeather Williams, CMD RTT (R)(T)

Clinical Manager, Radiation Therapy

Meet our team

Cancer Treatment Locations:

St. Francis Cancer Treatment Center2116 West Faidley AvenueGrand Island, NE 68803(308) 398-5450

St. Francis Cancer Treatment Center2nd Street & Marian RoadHastings, NE 68901(402) 461-5588

Visit us online:

http://chihealthstfrancis.org/

St. Francis2620 West Faidley AvenueGrand Island, NE 68803

Genetic CounselingWhile mutations in MLH1, MSH2, MSH6, or PMS2 genes are responsible for families Lynch syndrome, other conditions (and therefore other genes) may appear clinically similar to Lynch syndrome. In addition, in many families the cancer may be due to a combination of genetic and environmental factors. For this reason, a detailed review of the family history by a genetics professional is important before pursuing any type of genetic testing. Genetic test results can be complicated and are most useful when interpreted by a genetics professional in the context of an individual’s complete personal and family history. It is important to consider both the pros and cons of genetic testing before pursuing such tests.

At the St. Francis Cancer Treatment Center, genetic counseling is offered by our Certified Genetic Counselor Kim Brussow MS, LCGC. Appointments are free of charge, and can be made by calling Kim directly at (308) 865-7290. Genetic counseling is offered for all types of hereditary cancer syndromes, for patients with a diagnosis of cancer or a family history of cancer. Our Genetic Counsleing Services data has been accepted for publication at the upcoming June 2015 ASCO meeting. v

Resources• National Comprehensive Cancer Network, NCCN Clinical Practice Guidelines in

Oncology: Colorectal Cancer Screening, v.1.2012 retrieved April 24, 2012, from www.nccn.org

• Lynch Syndrome International, www.lynchcancers.com• Cancer Genetic Counseling Services (GCS) at St. Francis Cancer Treatment Center

www.asco.org and jco.ascopubs.org

Lynch Syndrome(continued from page 6)