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The Nebraska Medical Center
University Tower, Third Floor
Private Dining Rooms
Meal at 5 p.m.
Presentation from 5:30 to 6:30 p.m.
Presentation topic: Personality Changes Related to Brain Tumors by Deborah S. Hoffnung, PhD, ABPP and Larra Petersen, PhD
Please call the Social Work department at 402-559-4420 if you plan to attend.
The Nebraska Medical Center
University Tower, 3rd floor, Private Dining Room C
Meal 5 to 5:30 p.m.
Presentation from 5:30 to 6:30 p.m.
Presentation topic: Diet Resolutions for the New Year--Eating for a Healthy You, by Nicole Fox, RD, LMNT, CNSD, Medical Nutrition Therapist Specialist
Please call the Social Work department at 402-559-4420 if you plan to attend.
At the Ambassador of Hope Gala held recently, the following question was asked of the people in attendance, "How many of you here tonight have had cancer, had a family member or close friend with cancer?" The answer did not surprise me, but it was still astounding to see 99 percent of the several hundred people in the room raise their hands. As a practicing radiation oncologist for the past 21 years and one of the attendees in the room that night who raised their hand, I have seen the look of shock, fear, loneliness and isolation when a patient hears the words "cancer," "tumor," or "malignancy."
Following the diagnosis of cancer, patients usually undergo a series of diagnostic tests possibly including radiology imaging exams, additional biopsies and lab tests. This process is all part of the term to which cancer physicians refer as "staging." From these procedures the patient and their oncology physicians learn information which will guide treatment recommendations.
Patients seeking cancer care at The Nebraska Medical Center soon realize they are not alone but have a large team of specialists working on their behalf. The medical center often uses the phrase "multidisciplinary cancer care."
At The Nebraska Medical Center, there are multiple levels of multidisciplinary cancer care. First a tumor board conference is held. At this conference, most newly diagnosed cancer patient cases are discussed. Almost every tumor conference will have multiple cancer specialists present including surgical oncologists, medical oncologists, radiation oncologists, pathologists and radiologists. Oncology nurse case workers and tumor registry staff members also participate in the meeting.
This group discusses treatment options and recommendations based on a particular patient’s cancer history, the staging of the cancer and individual factors. Frequently, the treatment may involve a combination of surgery, radiation therapy and chemotherapy. Multidisciplinary approach to care has become the best practice, and there are general oncology tumor boards held at hospitals within the region.
The Nebraska Medical Center offers the disease-specific tumor boards on a regular basis. These tumor boards will have the same members in attendance as in the general oncology tumor board with one very important difference; all the specialists have specific interest, education and experience in that particular type of cancer whether it is lung, breast, lymphoma, gastrointestinal, head and neck, neurological, sarcoma, or gynecologic cancer. I am consistently impressed to see the level of knowledge of the oncology subspecialists in the disease-specific tumor boards. Gastroenterologists, pulmonologists, endocrinologists and even dental specialists attend these meetings as the cases call for their expertise.
The medical center also offers patients disease-specific tumor clinics. These clinics are held weekly and allow the oncology specialists to work closely together and allow the patient to see several sub-specialists in one office visit. The oncologists at the medical center frequently update each other on the latest publications pertinent to a patient who is being seen. On this campus, we work together and challenge each other to determine the best possible outcome for each patient.
The National Comprehensive Cancer Network (NCCN) is an alliance of the world’s leading cancer centers, working together to develop national treatment guidelines for cancers based on the latest research. The UNMC Eppley Cancer Center with The Nebraska Medical Center as its clinical partner is one of the founding members of the NCCN. It is a unique honor to serve on their national multidisciplinary committees that develop the natural treatment guidelines for specific type of cancers. Those guidelines are updated annually and frequently more often based on newly published clinical trials or newly approved therapies by the Food and Drug Administration.
During the recent Breast Cancer Education and Support Group, Ann Berger, PhD, APRN, shared a presentation about the cognitive side effects some cancer patients experience with treatments . She encourages patients to limit distractions, keep a routine, plan breaks during activities and summarize back to others what has been communicated in order to improve attention span and ability to concentrate.
In effort to manage memory difficulties, she suggests making lists (such as for groceries or other household supplies), writing down thoughts or questions before having a conversation, using a highlighter to note important items and bringing a tape recorder to important meetings.
For more information on the cognitive side effects of chemotherapy please consider reading “Your Brain after Chemo: A Practical Guide to Lifting the Fog and Getting Back Your Focus” by Dan Silverman and Idelle Davidson.
During a recent support group, Nicole Shonka, MD suggested reading cancer related studies with a very critical eye.
"Make sure the studies are published in meaningful medical journals where claims are supported by scientific studies, not just patient reports. It is also important to consider if the claims supported by the scientific studies are related to humans, rather than test animals," she said.
Diagnosing a younger woman with breast cancer can interfere with many important things in her life. These would include the option to have children, dealing with early onset of menopause, genetic testing and simply the confidence in planning for a future. For the single woman the question arises how to meet a new prospective life partner and find the right time and place to tell them about the breast cancer experience. I emphasize to younger women with breast cancer that this is not a death sentence and the majority of women of all ages with breast cancer are cured. I also convey to them, in the majority of cases, the breast can be spared with breast conservation surgery and that with the advances being made in the area of chemotherapy, survival rates for breast cancer are increasing.
There are numerous ways that a young woman can reduce their risk for developing breast cancer. Two of the more common risk factors for young women are obesity and excessive drinking. By maintaining a healthy weight, curtailing excessive alcohol consumption and educating themselves about the benefits of detecting breast cancer early, a young woman may decrease the risk of developing breast cancer.
Despite the controversy that has surrounded screening mammography in the last year, the recommendations of the American Cancer Society remain the same, specifically that for most women they should get their first mammogram by the age of 40 and annually thereafter. The recommended age is 40 because mammography is not as effective of a screening tool for younger women, because the breasts are denser and it is harder to see small cancers in this setting. A strong family history of breast cancer among first degree relatives can put young women in a high-risk group. Other risk factors include an early age at the start of menstruation, taking hormones such as Estrogen or Progesterone (hormones used in oral contraceptives) over a long period of time, obesity and excessive drinking.
While breast self-examination is no longer a recommendation of the American Cancer Society, its potential use should be discussed along with the risk and benefits for a woman starting in her 20's. Women who are comfortable with breast self-examination should have a systematic and monthly approach to looking at an examining their own breast. The optimal time in the menstrual cycle to carry out breast self examination is between days 12 to 15, assuming the young woman’s cycle is regular. It should be noted that most early stage breast cancers do not produce any symptoms. The most common sign is a painless mass. The importance of noticing changes to the contour of the breast and possible development of swelling, dimpling, nipple retraction, skin thickening and nipple discharge along with identifying a palpable finding should be brought to the attention of their healthcare provider. Any lump that persists past one or two cycles should be brought to the attention of the health-care provider.
