Our Passion, Your Health

Our Passion | Your Health features stories on the latest happenings at Penn State Health St. Joseph. Check out our blogs, recipes, patient stories, program highlights, and new services that represent our passion...your health.

Liver Cancer Patients Have Local Access to Minimally Invasive, Life-Extending Treatment at Penn State Health St. Joseph Cancer Center

Originally Published in Central Pennsylvania MD News on October 18, 2018

Penn State Health St. Joseph Cancer Center integrates tissue-sparing yttrium-90 selective internal radiation therapy (Y-90 SIRT) into treatment of liver cancer, offering many local patients improved outcomes over conventional treatments alone.

Survival Benefit

For patients with metastatic right-sided colorectal cancer liver metastases, yttrium-90 selective internal radiation therapy (Y-90 SIRT) in addition to chemotherapy yields increased overall survival of approximately five months compared with chemotherapy alone, according to a study in Clinical Colorectal Cancer that was co-authored by Navesh Sharma, DO, PhD, FACRO, section chief of Radiation Oncology at Penn State Health St. Joseph Cancer Center and associate professor of radiation oncology at Penn State College of Medicine.

In patients with liver-only metastases from colorectal cancer, Y-90 SIRT in addition to chemotherapy improves control of disease in the liver by approximately eight months, according to a study led by Dr. Sharma and published in the Journal of Clinical Oncology

Y-90 SIRT is indicated for a wide range of patients with cancer in the liver, including those who are not candidates for surgery, and its local availability and the expertise at Penn State Health St. Joseph Cancer Center spare them the need to travel to major metropolitan facilities.

A Focus on Precision

Limiting damage to healthy tissue by precisely targeting cancer cells during radiation therapy is crucial because the liver is especially sensitive.

“A low dose of radiation to the entire liver can do great harm to a patient,” says Navesh Sharma, DO, PhD, FACRO, section chief of Radiation Oncology at Penn State Health St. Joseph Cancer Center and associate professor of radiation oncology at Penn State College of Medicine. “That’s why Y-90 SIRT is indicated for patients with liver-predominant disease that poses a risk for immediate liver-related problems.”

Y-90 SIRT delivers radiation to cancerous liver tumors through millions of resin microspheres containing yttrium-90. The procedure involves inserting a catheter into the femoral or radial artery through a small incision in the groin. The catheter is threaded to blood vessels that feed the tumors, and the spheres are delivered through the catheter.

“Yttrium-90 is a beta emitter, which emits radiation for only short distances,” Dr. Sharma explains. “That enables us to deliver a high dose to tumors without the radiation spreading too far, thus protecting the rest of the liver.”

Prior to the procedure, an arteriogram maps the area’s blood vessels, some of which are then blocked off to ensure the microspheres do not travel outside the prescribed area. The brevity of the procedure on the day of treatment — less than two hours, including half an hour to infuse the spheres — allows patients to return home from Penn State Health St. Joseph Cancer Center the same day.

Accurate Timing

The oncology team at Penn State Health St. Joseph Cancer Center maintains robust communication throughout a patient’s course of treatment to ensure optimal timing of Y-90 SIRT.

High-Level Expertise

A board-certified radiation oncologist, Navesh Sharma, DO, PhD, FACRO, section chief of Radiation Oncology at Penn State Health St. Joseph Cancer Center and associate professor of radiation oncology at Penn State College of Medicine, is an internationally recognized expert in yttrium-90 selective internal radiation therapy (Y-90 SIRT).

Dr. Sharma served as the United States’ principal investigator for an international phase III clinical trial on Y-90 SIRT that was published in the Journal of Clinical Oncology in 2016 and The Lancet Oncology in 2017.

“I’ve been involved with the procedure since 2010 and previously led one of the largest Y-90 SIRT programs in the country,” he says. “I’ve spent a lot of time learning the accurate dosimetry and application of Y-90 SIRT and its appropriate integration into the continuum of cancer care for patients.”

“Specialists in interventional radiology, radiation and medical oncology are all on the same floor as I am, so we can plan Y-90 SIRT before chemotherapy has even begun,” Dr. Sharma says. “We treat patients in a way that complements the flow of other treatments they are undergoing. That level of multidisciplinary collaboration in a high-volume center such as ours is rare.”

Lifesaving Care, Rapid Recovery

Thomas Souders, who was diagnosed with stage IV pancreatic cancer in 2012 and learned it had metastasized to his liver in 2015, has benefited from Dr. Sharma’s expertise. In 2015, Souders underwent Y-90 SIRT after having previously undergone chemotherapy.

“I was able to make it through Y-90 treatment much easier than chemotherapy,” he recalls. “It was more comfortable, and I had a quicker recovery. I even fell asleep during the procedure itself, and I was out of the hospital within an hour after it was over.”

Chemotherapy required him to visit the treatment center four times weekly for multiple weeks, whereas Y-90 SIRT required only three visits over three days. The first was to map the arteries that would carry the microspheres; the second and third were to administer treatment.

Souders doubts he would have known about Y-90 SIRT were it not for its local availability at Penn State Health St. Joseph Cancer Center. He believes that without the treatment, he would not be alive.

“The sooner patients seek treatment options, the better,” Dr. Sharma says. “In the past, the stage IV colorectal cancer survival rate was four to six months. Now, it’s over two years. Offering targeted Y-90 therapy for patients with liver-predominant disease allows them to sometimes get breaks from more toxic chemotherapy and improves their control of disease in the liver based on clinical trials. Integrating chemotherapy and Y-90 SIRT appropriately is what we are able to do well with the experience and open interaction we have here at St. Joseph Cancer Center.”

To learn more about Y-90 SIRT at Penn State Health St. Joseph Cancer Center or to refer a patient, visit thefutureofhealthcare.org/cancer-center/y-90 or call 610-898-SIRT (7478).

Breast Care Patient Navigators Help Ease the Burden for Women in our Community

Featured in Palo Magazine

Anyone who has been diagnosed with breast cancer or informed of an abnormal mammogram can tell you those experiences are frightening and raise many questions.

Will I require surgery? Do I need radiation or chemotherapy? Who will care for my children? How will I get to appointments? What will my insurance pay for or not pay for? Am I going to be okay?

Navigating the healthcare system can be a daunting task under any circumstances, and language and cultural differences can make it even more difficult. That’s why Penn State Health St. Joseph has expanded its team of breast health care navigators to provide personalized services in both English and Spanish.

Ready to assist patients with every step through diagnosis, treatment and recovery, navigators counsel patients regarding care they’ll receive and what they might expect during treatment. They discuss treatment options, help women find insurance or financial assistance and coordinate medical appointments. They make referrals, help uninsured women get breast screenings and fit mastectomy patients with special undergarments and clothing.

Most importantly, St. Joseph navigators provide emotional support and understanding that, in some cases, comes from first-hand experience.

“I tell women that I understand exactly what they’re going through, because I do,” said Patient Navigator Maria Jimenez, a breast cancer survivor. “I am with them every step of the way because I went through the same thing they are going through.”

Other Penn State Health breast care navigators are Lisa Spencer and Anne Welsh, who supervises mammography at the hospital.

Spencer, the original oncology patient navigator, recognized that she needed help to effectively serve Penn State Health St. Joseph’s Hispanic patients.

“I found I could not serve the Hispanic community well,” said Spencer, who speaks limited Spanish. “But, Maria, who is a survivor herself, can offer services in a patient’s own language and that makes people very comfortable.”

Spencer and Jimenez are both trained mastectomy fitters and work closely with patients who have undergone surgery, are anticipating surgery or are in need of other, related services.

All the navigators work closely with Nancy Fonseca, St. Joseph’s oncology social worker and care manager, who also speaks fluent Spanish.

One of the most important parts of Fonseca’s job is helping women obtain some form of health insurance.

“We’re trying to help people to get onto some kind of insurance so they can take care of themselves,” she said.

She also works to assure that patients have the support they need during and after treatment, and to remove obstacles that may make it difficult for a woman to get the care that she needs.

Working together, Fonseca and the breast health care navigators care for the particular needs of each patient.

“As a team, we work to see how we can pool our resources to help patients,” said Fonseca, who also is a breast cancer survivor. “We feel proud of what we do because we are very personal with each patient. No patient goes home without the assistance that they need.”

Lisa Spencer, M.Ed., BSRT(T), OPN-CG, CN-BI, Breast Care Patient Navigator | Maria Jimenez, Patient Navigator

If you’ve been diagnosed with breast cancer and would like the support of a Patient Navigator, contact Lisa or and let her be your personal guide. 610-378-2959 | lspencer2@pennstatehealth.psu.edu mjimenez1@pennstatehealth.psu.edu

2D vs. 3D Mammogram: When to Have the Upgrade

The latest mammogram technology for breast cancer screening is now available at Penn State Health St. Joseph’s Bern and Exeter locations, providing patients with an additional option for their care.

St. Joseph’s offers 3D mammography, also known as breast tomosynthesis, an advanced technology that takes multiple images of breast tissue and recreates a 3D picture of the breast. 3D mammograms have higher cancer detection rates than standard 2D mammograms, and also result in fewer patient callbacks.

Dr. Steven Chmielewski, a radiologist with Penn State Health St. Joseph, explained that 3D tomosynthesis provides multiple thin slice images of the breast, enabling radiologists to view each image separately. That avoids the issue of overlapping tissue, which can hide small cancers in a conventional mammogram.

“By minimizing the effects of overlapping tissue with 3D tomosynthesis, we can provide a more accurate, confident and earlier diagnosis,” Chmielewski said.

Because the images produced with 3D mammograms are clearer and easier to read, there is less need to bring patients back in for further screening.

“We’re finding that with 3D mammograms the recall rate is less because we can see more,” said Lynn Kaufman, director of imaging at Penn State Health St. Joseph.

The process for a patient getting a 3D mammogram is no different from that of getting a 2D, although the 3D does deliver a bit more radiation. The radiation dose from a 3D mammogram, however, is still well within FDA approved limits. Both 2D and 3D mammograms are low-dose x-rays.

3D mammograms are particularly important for women who have dense breast tissue, meaning that their breasts contain more glandular tissue compared to fatty tissue.

While fatty tissue appears gray on a mammogram, glandular tissue appears white – as does cancer. This means that women with dense breast tissue experienced more frequent callbacks because the x-rays were often difficult to read. Radiologists can get a much clearer look at the breast with 3D mammograms, making it easier to differentiate glandular tissue from cancer cells.

Reducing the number of callbacks for patients with dense breast tissue not only increases the comfort level of those patients, but may make women more likely to get mammograms on a regular basis.

“Since we will be reducing the callback rate for screening studies, particularly in patients with dense breast, I hope to lessen the anxiety associated with mammography, and improve compliance with this improved screening tool,” Chmielewski said.

It’s important for patients to understand the differences between 2D and 3D mammograms, because they typically will decide which type of x-ray they will receive, explained Kaufman. While most insurances now cover 3D mammograms, some do not, meaning that patients could be charged a fee for the advanced technology.

“Patients should always check with their insurance providers to make sure that they’re covered,” Kaufman said.

Women undergoing screening mammograms – those that are routinely administered to detect cancer in patients who have no symptoms – are given the option of having either a 2D or 3D procedure. Anyone who has experienced a problem and has been referred for a diagnostic mammogram, however, will be very strongly encouraged to opt for a 3D mammogram.

“If diagnostic is needed, we will definitely recommend that women do a 3D,” Kaufman said.

Mammograms are an essential – although sometimes underutilized – part of routine health care. According to Kaufman, Penn State Health St. Joseph is looking to reduce or remove barriers such as language, transportation, time constraints and immigration status that sometimes prevent women, both insured and uninsured, from getting mammograms.

“We’re going to work on ways to get more women to be compliant for screening,” Kaufman said.

Regardless of whether a woman chooses 2D or 3D technology, mammograms are an important piece of a woman’s health care, said Anne Welsh, lead mammography specialist at Penn State Health St. Joseph.

“Mammography is still the gold standard in breast imaging, and it is the first step in the screening process,” Welsh said. “2D is, and continues to be a benefit to patients, while 3D tomosynthesis is an advantage that makes the gold standard even more important, especially for women with dense breasts.”

In addition to the 3D systems in place at St. Joseph’s Exeter and Bern locations, patients may also have access to systems at Penn State Health Milton S. Hershey Medical Center. Efforts also are underway to make 3D screening available at St. Joseph’s Downtown Campus.

Ready for a Mammogram? Call 610-378-2100 to schedule an appointment.

Cancer Center Expansion Offers New Cutting-Edge Treatment Options for Berks Community

The Nittany Lion joined in the festivities as a crowd of 75 celebrated the groundbreaking of a new $5.5 million addition to the Penn State Health St. Joseph Cancer Center in April.

By year’s end, patients in the Berks region will benefit from faster, more targeted radiation treatments that are also more comfortable, more precise and come with fewer side effects.

“Our overall mission is to bring hope and healing closer to home, and this allows us to make that happen,” said Dr. Navesh Sharma, associate professor of radiology and chief of radiation oncology for the Cancer Center.

Scheduled to open by year’s end, the 2,400-square-foot addition will accommodate both a growing patient base, as well as a new, state-of-the-art TrueBeam® linear accelerator.

“With this TrueBeam® technology, we have some extremely sophisticated tumor tracking and imaging capabilities,” says Karen Wagner, St. Joseph’s director of oncology services. “The real value of this technology is that it will enable St. Joseph to offer patients options that were previously unavailable here.”

For patients, the expanded Cancer Center will offer a few key benefits:

  • Health care providers can tailor individualized treatment plans much more precisely, drastically reducing treatment time
  • More patients will qualify for nonsurgical alternatives that are less invasive, faster to perform and offer faster recoveries
  • Local patients receive state-of-the-art treatment closer to home

The hallmark of the TrueBeam® linear accelerator is a powerful combination of 2D, 3D and 4D imaging that is updated every 10 milliseconds, monitors a patient’s breathing and body movement and permits faster, more potent radiation doses directly to a tumor site without damage to surrounding tissue or nearby organs.

Dr. Marc Rovito, medical director for the St. Joseph Cancer Center, expressed his gratitude to Penn State Health for its continued commitment to providing high-quality care locally.

“Currently, these patients have to go elsewhere for the TrueBeam® treatment option, but they will not in the future,” Rovito said. “Through Penn State Health providers, cancer patients will have access to the incredible resources of a renowned university teaching and research hospital while receiving high-quality care close to home.”

St. Joseph Cancer Center provides state-of-the-art cancer treatment, including genetic education, counseling and testing for people at high cancer risk, minimally invasive internal radiation therapy for liver tumors and cutting-edge clinical trials research for new cancer treatments.

Penn State Health St. Joseph Cancer Center Cancer Center features a multidisciplinary team of specialists who are dedicated to accurate cancer diagnosis and staging, innovative and appropriate treatment, collaborative relationships with each patient's physicians, and attention to the care of patients and their families. If you or loved one would like to learn more, contact us at 6140-208-8810 or email at info@thefutureofhealthcare.org

Navigating Her Own Cancer Diagnosis

Maria Jimenez was born and raised in Puerto Rico and arrived in Reading in 1984.

She worked at many jobs as she raised 2 children. She had a “good life” but wanted to improve herself.

So, at age 53, Maria began college with the dream of working in healthcare.

In 2015, she graduated from Alvernia University with a BS in Healthcare Science. During her senior year, Maria “shadowed” St. Joseph’s Oncology Social Worker and Breast Care Patient Navigator and, after that experience, decided that becoming a Navigator would be a perfect career for her!

And her timing was perfect, too!

The year she graduated, St. Joe’s was the recipient of a Grant from the Susan G. Komen Foundation. The grant was to hire a full-time Bilingual Navigator, known in the Latino community as a Promotora. After being hired, Maria attended the Harold P. Freeman Patient Navigation Institute in New York City for the specialized training needed for her new role.

In the ensuing 18 months, she found her life’s calling. She was devoted to assisting women, especially Reading’s large Latino community, to learn about the importance of breast health and mammograms.

She was immersed in her new job and life was good to her.

Then, in April 2017, she found a lump in one of her own breasts.

A mammogram and ultrasound was followed by a biopsy; the news was not good: She was diagnosed with stage IIB breast cancer.

Maria needed chemotherapy, surgery, and radiation therapy; she lost her hair and took a leave from the job she loved. She was quite sick from the side effects of treatment, but yearned to return to the work she felt so passionate about.

Finally, just this October 2, Maria was back, with the realization that, more than ever, she was uniquely qualified to be a Promotora. While she still needs infusions and radiation therapy, she believes “the worst is over.” And, as if her professional mission needed clarity, she recognizes that her personal experience will be invaluable as she helps patients to deal with a cancer diagnosis and treatment.

A Proven Approach to Stop Smoking

Thinking about quitting but don’t know where to start?

Our Smoking Cessation Group has had great outcomes because we support you through the difficult process. Learn more about this multi-week group beginning September 19th.

Know Your Risk: Cancer Risk Evaluation Program

If you’re concerned about your risks for developing breast, ovarian cancer, colorectal or other hereditary cancers, the experts in our Cancer Risk Evaluation Program can help. Our doctors and nurses will provide information, evaluation, genetic counseling, and genetic testing, if appropriate, to assist in developing a realistic opinion of your risk status. As an affiliate of the Penn State Hershey Cancer Institute, our Cancer Risk Evaluation Program Coordinator, Donna Lamp, RN, BSN, CCM and Medical Director, Dr. Marc A. Rovito, work collaboratively with Penn State Hershey Medical Geneticist, Maria Baker, Ph.D. and your physicians to review your personal and family history, create a cancer- incidence pedigree (family tree), and offer recommendations for follow-up.

Our experienced oncology professionals will:

  • Determine your risk for developing a hereditary cancer;
  • Assist in developing a realistic opinion of a woman’s breast cancer risk status;
  • Recommend a plan for ongoing screening and risk reduction approaches;
  • Help women understand current breast health management issues and research studies related to breast cancer prevention, diagnosis and treatment;
  • Explain the genetics of breast cancer and, when indicated, provide counseling and access to genetic testing;
  • Provide access to appropriate clinical research studies related to breast health or genetic testing consideration for women found to be at high risk;
  • Recommend a plan for ongoing screening and risk reduction approaches for individuals with Lynch Syndrome and other known cancer-related genetic syndromes;
  • Collaborate with medical oncology specialists, surgeons, and pathologists in order to identify individuals at risk for Lynch Syndrome, which include cancers such as colorectal, uterine and or ovarian, and based on personal and family history, provide screening and risk reduction strategies for these patients and their families.

Donna Lamp, RN, BSN, CCM, Coordinator of Cancer Risk Evaluation Program If you’re ready to assess your risk for developing breast, ovarian, and other hereditary cancers, or for more information on the process, contact Donna and let her be your personal guide. 610-378-2457   |   DLamp@PennStateHealth.psu.edu

Celebrating Breast Cancer Awareness Month with Early Detection

Breast cancer is today’s second leading cause of cancer death in American women. While research continues to seek ways to prevent, detect, and treat this disease, it is essential for you to stay informed – so that you can make smart decisions about your health.

mam

Free mammograms are offered to uninsured or underinsured women through a Susan G. Komen grant. Call 610-378-2959 to schedule your appointment.

If you are covered by insurance and would like to have a mammogram, contact your family physician for a prescription. You may then call 610-378-2100 to schedule your appointment.

Celebrating Breast Cancer Awareness Month with Risk Assessments

If you’re concerned about your risks for developing breast, ovarian cancer, colorectal or other hereditary cancers, the experts in our Cancer Risk Evaluation Program (CREP) can help. Our doctors and nurses will provide information, evaluation, genetic counseling, and genetic testing, if appropriate, to assist in developing a realistic opinion of your risk status. Our Cancer Risk Evaluation Program Coordinator, Donna Lamp, RN, BSN, CCM and Medical Director, Dr. Marc A. Rovito, work collaboratively with Penn State Hershey Medical Geneticist, Maria Baker, Ph.D. and your physicians to review your personal and family history, create a cancer- incidence pedigree (family tree), and offer recommendations for follow-up.

Donna Lamp, RN, BSN, CCM, Coordinator of Cancer Risk Evaluation Program If you’re ready to assess your risk for developing breast, ovarian, and other hereditary cancers, or for more information on the process, contact Donna and let her be your personal guide. 610-378-2457   |   DLamp@PennStateHealth.psu.edu

Lab makes donation to Cancer Center

“Each year our laboratory selects a charitable cause to support for Lab Week,” reported Lori Grauer, Laboratory Client Services/Marketing Manager. The recipient of the 2016 Outreach Project, sponsored by the Laboratory at Penn State Health St. Joseph, is the Cancer Center. The laboratory staff generously donated items for gift baskets and raised $600 through a silent auction of gift baskets and the sale of potted plants that were donated by a lab employee. The Lab Week Committee purchased twenty-four $25 gas gift cards (8 Wawa/8 Sheetz/8 Top Star) for patients who are undergoing cancer treatment.

Pictured L-R:  Karen Wagner, Director of Oncology Services, Diane Ross, M.T. - Lab Week Chair, Marc Rovito, MD, PSHSJ Cancer Center Medical Director.
Pictured L-R: Karen Wagner, Director of Oncology Services, Diane Ross, M.T. – Lab Week Chair, Marc Rovito, MD, PSHSJ Cancer Center Medical Director.

“We are thrilled and very grateful to our Laboratory colleagues for thinking of our patients in this way. The Lab staff has always been so generous in raising money to support those in need. We have patients and families who struggle emotionally, as well as financially, while undergoing cancer treatment. These patients will surely appreciate the gift of a gas card to help them with transportation expenses. And, the fact that hospital staff working in the Lab have provided the gas card makes the gift even more meaningful,” commented Karen Wagner, Director, Oncology Services. Thank you, PSHSJ Laboratory Services!