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There are many publications and sites that write about cancer. We want you to know we don’t produce the news items you can read in this section, they belong to the MD Anderson Cancer Center. This section only intents to inform you about what is out there.

However, we are working on the first edition of the Pink Ribbon Magazine as well as in the production of featured articles that will be published here.

 

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Nurses on the front lines of immunotherapy

A patient writes, “The Astros will win the World Series next year,” in bold print as Jaquelin Velasquez watches. The clinical nurse in Lymphoma and Myeloma isn’t interested in the accuracy of this prediction. She’s looking for signs of a serious side effect of immunotherapy.

“If a patient’s handwriting deteriorates, it’s a red flag that they’re developing neurotoxicity,” Velasquez says. She explains that the handwriting test is part of a neurological assessment developed at MD Anderson for patients receiving CAR T-cell therapy.

“Neurotoxicity can be fatal if we don’t intervene early and reverse the effects,” she says. 

Velasquez has cared for immunotherapy patients since the first CAR T-cell therapy clinical trial here in 2015. The therapy involves the removal of a patient’s own T cells, which are then reengineered to find and destroy cancer proteins or targets. Next the cells are infused back into the patient’s body, where they attack the cancer cells. While there’s been great success with this type of treatment, it comes with a unique profile of toxicities that can be life-threatening.

Making immunotherapy a safer treatment option

Velasquez is one of many clinical, advanced practice and research nurses throughout MD Anderson who collaborate across the institution and the nation to identify and manage toxicity in patients treated with immunotherapy and thus bring a higher level of safety to this innovative treatment option.

“On the front line of patient care, our nurses have been instrumental in helping us deliver immunotherapies in a safe fashion,” says Partow Kebriaei, M.D., a professor of Stem Cell Transplantation and Cellular Therapy. “Since the beginning, they’ve really led the charge in creating educational resources and collaborating with physicians and pharmacists to develop the ground rules for toxicity management and patient safety.”

Leading through innovation

Advanced practice registered nurse Sherry Adkins has seen the side effects of CAR T-cell therapy first-hand. She describes cytokine release syndrome as being similar to a severe case of the flu with high fever, fatigue and body aches. Cytokine release syndrome also can develop into a high-grade syndrome associated with life-threatening consequences. In addition to deteriorating handwriting, neurological toxicities may include confusion, difficulty speaking and seizures. 

In her work managing CAR T clinical trials, Adkins contributed to a multidisciplinary team that composed guidelines for handling those side effects, which usually are reversible if caught early.

The guidelines include a system for grading toxicities, as well as treatment plans for side effects depending upon their severity.

Partnering with informatics, Adkins and her nursing colleagues further refined the process for toxicity management by creating an automated documentation tool, or “flowsheet,” for immunotherapy-related toxicities in a patient’s electronic health record.

This allowed for standardized documentation, data reporting and tracking of immune-related toxicities.

In addition, Adkins collaborated with Informatics to create a mobile app that automates the process for grading toxicities related to CAR T therapy. Her goal is to make it as simple as possible for all clinicians to accurately grade and manage side effects.

“Clinicians have said they feel more confident in the assessment and grading of toxicities,” says Adkins, adding that physicians find the app helpful when they get a call in the middle of the night.

“They can access the app right then and there to ensure the right intervention is implemented at the right time.”

An evolving role in immunotherapy treatment

As immunotherapy treatments rapidly evolve, so do the roles of nurses.

After being involved with clinical trials and seeing Yescarta therapy become FDA-approved for CAR T patients last year, registered nurse Misha Hawkins applied her expertise to a newly created position at MD Anderson: cell therapy coordinator for lymphoma. Since then, she’s managed about 50 patients from pre- to post-treatment, keeping detailed documentation on each person.

“For 99% of infusions that happen on inpatient units, I’m here to assist the nurses and monitor patients if they start having side effects,” she says. “As nurses, we’re the eyes and ears for the physicians when they can’t be in the room, so being able to accurately describe and assess what’s happening is very critical to the care and safety of the patient.”

The documentation Hawkins records not only helps current patients, but it may help future patients, as well. She’s working with an interdisciplinary team to review the data and determine what factors cause some patients to have serious side effects, while others may experience mild or no effects.

Continuous immunotherapy education

Most MD Anderson nurses now are required to take some form of immunotherapy training.

“As immunotherapy becomes available to treat more cancer types and more patients, it’s critical for everyone to be educated on the latest developments and best practices,” says Joaquin Buitrago, a nurse educator who has pioneered nursing immunotherapy education.

Buitrago is constantly updating immunotherapy curriculum as new information comes out. He recently played a key role in ensuring nurses were properly trained as MD Anderson became the first stand-alone immune effector cell program to be accredited by the Foundation for the Accreditation of Cellular Therapy. Now, Buitrago is excited to add a new training to the curriculum – this time, focusing on life after cancer, as many immunotherapy patients are nearing the five-year survivorship milestone.

“It’s exciting to be part of a team that’s making groundbreaking advancements in cancer care,” says Buitrago. “There are no limits for nurses.”

A longer version of this story originally appeared in Messenger, MD Anderson’s quarterly publication for employees, volunteers, retirees and their families.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Astrocytoma survivor: I feel lucky

How often does a brain tumor save your life? In Kellilyn Monar’s case, it may have done just that. She’d planned to be at the Route 91 Music Harvest Festival in her hometown of Las Vegas on Oct. 1, 2017. But a brain tumor diagnosis interrupted those plans.

“I go every year, but because my surgery was scheduled that week, I called to get a refund on my tickets,” she says. When the concert became the site of the deadliest mass shooting in U.S. history, Kellilyn was safely at home, preparing to travel to Houston for her brain tumor surgery.

“In a way, MD Anderson may have saved my life twice,” she says.

Simple seizure: an early brain tumor symptom

Kellilyn had learned she had a brain tumor two months earlier. She didn’t know the episodes of numbness that traveled up her right leg to her face were simple motor seizures. She thought they were spasms from the back pain that had been growing worse for several months.

“One day I was getting onto the elevator with my boss, and it happened again,” Kellilyn recalls. “He said, ‘That’s not your back, that’s your head. You need to go to the hospital.’”

He turned out to be right: an MRI in the emergency room revealed Kellilyn had a large tumor in the left frontal and temporal lobes of her brain. She had her biopsy in Las Vegas, and learned it was a grade II astrocytoma. But Kellilyn wasn’t comfortable moving forward with further treatment at her local hospital.

“They recommended radiation and chemotherapy to treat the tumor, but also said I’d have massive damage to healthy brain cells,” Kellilyn says. “That was unacceptable.”

Seeking a second opinion

Her family sought a second opinion to see if surgery was an option. A neurosurgeon at another hospital recommended an awake craniotomy, a specialized neurosurgical procedure in which the patient is painlessly awoken during surgery to help map critical brain functions while the tumor is removed.

The oncology panel assessing Kellilyn’s case didn’t accept his recommendation, but her parents were convinced surgery would provide the best results.

Where you go first matters

“My dad said we only have one chance to make the best decision,” Kellilyn says. “If we made the wrong decision first, our next steps would be limited.” After reading that U.S. News & World Report ranked MD Anderson as the No. 1 hospital for cancer care in the country, they requested an appointment.

Choosing MD Anderson for brain tumor treatment

Even though MD Anderson was recovering from Hurricane Harvey, Kellilyn was quickly scheduled to see neuro-oncologist Carlos Kamiya-Matsuoka, M.D., in MD Anderson’s Brain and Spine Center. He referred her to neurosurgeon Sujit Prabhu, M.D., who strongly advocated for an awake craniotomy.

“I was so impressed with their professionalism and care that I decided to put my future in the capable hands of the MD Anderson team,” Kellilyn says.

Preparing for a successful brain tumor surgery

Once her awake craniotomy was scheduled, Kellilyn was surprised to learn she’d need to arrive at MD Anderson several days beforehand for two full days of more testing.

“I thought they’d just open my head and go in,” Kellilyn says. “But Dr. Prabhu explained that’s not how MD Anderson does surgery for brain tumors like mine.”

The pre-surgical testing included a neuropsychological evaluation, functional MRI and transcranial magnetic stimulation. The tests were the first step in assessing Kellilyn’s cognitive function and mapping her critical brain functions in preparation for surgery. Interestingly, the tests revealed that Kellilyn’s essential speech functions had reorganized from the left to the right side of her brain.

During the 18-hour operation, Kellilyn’s feedback helped Prabhu safely remove 95% of the brain tumor, while preserving her critical brain functions.  

After the awake craniotomy: Kellilyn’s side effects and recovery

After surgery, Kellilyn developed several short-term side effects, including blurry vision and trouble speaking (aphasia). She worked with Katherine Connelly, an MD Anderson speech language pathologist in rehabilitation services, and the symptoms resolved a few months after surgery.

Since then, Kellilyn has returned to her job in entertainment engineering and enrolled in a master’s degree program in Las Vegas. She returns to MD Anderson every three months for follow-up care.

“I’ve already won.”

During an early post-surgical visit, Kellilyn received great news: Not only was her brain showing remarkable plasticity in recovering from surgery, but her remaining “spot” of tumor was so minimal and stable that she wouldn’t require chemotherapy or radiation therapy.

“That was probably the best news I’d ever heard,” Kellilyn says. “Sometimes I think with how lucky I’ve been, now is a good time to play the lottery. But then I realize – I’ve already won.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789

Triple-negative breast cancer survivor sees only benefits from immunotherapy clinical trial

Lori Shults didn’t know much about clinical trials when she first came to MD Anderson in May 2017. “I thought they involved some people getting medicine and others just getting sugar pills,” she recalls. “That sounded too risky for me, so I wasn’t interested.”

Fortunately, the Hill Country school teacher soon learned that her understanding of clinical trials was both limited and inaccurate. She also learned that an innovative clinical trial being conducted as part of MD Anderson’s Breast Cancer Moon Shot™ could benefit her personally.

The trial would allow Lori to start her treatment with chemotherapy (the standard for triple-negative breast cancer) and pursue other options only if that proved ineffective.

“Once I realized I’d be getting what everyone else got, plus something extra if the conventional treatment didn’t work, I didn’t see a downside to it,” she says.

A team approach with individualized care

Lori was diagnosed with triple-negative breast cancer at age 38, after finding a lump in her right breast. She went to a local surgeon recommended by her gynecologist, but their miscommunications left her feeling even more anxious about her situation.

“The surgeon said I needed to have my breast removed right away,” says Lori, who decided then to come to MD Anderson. “But I don’t like being rushed. I also don’t like having to tell my whole story over again to every new doctor I meet. Not having everyone all together made it feel really chaotic.”

At MD Anderson, Lori met with her entire care team on the same day. They agreed that her treatment should start quickly. “But there wasn’t the same frantic sense of urgency,” Lori recalls. “I had time to breathe and ask questions.”

Lori needed to begin chemotherapy just as the school year was ending. Her oncologist, Stacy Moulder, M.D. made special accommodations to ensure she could still go on a much-anticipated summer vacation.

“It takes about a week to get a port installed to receive chemo infusions, and I didn’t want to miss out on my river trip, so my doctors let me receive my first infusion through a PIC line instead,” she says. “Knowing I didn’t have to put the rest of my life on hold for cancer meant the world to me.”

Choosing an immunotherapy clinical trial

Unfortunately, the standard chemotherapy cocktail of doxorubicin and cyclophosphamide was not as effective at shrinking Lori’s cancer before surgery as her doctors had hoped it would be. So, as part of the Moon Shot clinical trial, they analyzed her tumor and discovered she might benefit from a related immunotherapy trial.

That immunotherapy trial was also led by MD Anderson’s Breast Cancer Moon Shot team, which is driven to discover more effective, personalized treatment strategies that lead to more cures for triple-negative breast cancer. The Breast Cancer Moon Shot is part of MD Anderson’s Moon Shots Program, a collaborative effort to rapidly transform scientific discoveries into clinical advances that save patients’ lives.

Lori followed her doctors’ advice and switched to the immunotherapy clinical trial. She began receiving a new combination of drugs — the chemotherapy drug nab-paclitaxel and an immunotherapy drug called atezolizumab — in August 2017. As a part of the trial, Lori would get an IV infusion of the drugs once a week for four months, then have a mastectomy to remove the tumor. She would also receive the drugs for three months afterwards.

Fortunately, Lori’s cancer proved responsive to the new drug combination. “By the time the tumor was removed, it was all dead cells,” Lori says. “The cancer had been killed.”

Immediate vs. delayed reconstruction

Lori’s nipple-sparing mastectomy took place on Dec. 1, 2017, under Rosa Hwang, M.D. To minimize the amount of time she spent in recovery, Lori also had immediate reconstruction of her right breast under Mark Villa, M.D. He installed a permanent implant during the same procedure.

“I could have opted for a tissue expander instead,” Lori says. “But then I would’ve needed another surgery later on to take it out and replace it. I didn’t want to go through that twice if I could avoid it.”

Helping other women through clinical trial participation

Lori finished her treatments on Feb. 21, 2018, and she continues to show no evidence of disease today. And while she is grateful to be cancer-free, she’s also excited about the prospect of helping other women through her clinical trial participation.

“I looked at my friend’s 7-year-old twin daughters and thought, ‘If, God forbid, this should ever affect them someday, and I could make just one of their lives a little easier …,’” Lori says. “That was one of the main reasons I did this.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Warriors within our ranks: Military veterans at MD Anderson

Leadership. Dependability. Teamwork. Problem-solving. These attributes essential for U.S. service members also are highly sought after by top employers such as MD Anderson, and they’re just a few of the reasons recruiting and retaining veterans are priorities here.

“Veterans have numerous strengths, but at their core is a willingness to serve,” says Larry Perkins, Ph.D, who accumulated more than 35 years of experience in human resources, education, training and leadership development while in the Army and is now our associate vice president for talent and diversity. “We’ve had great success recruiting veterans in recent years because their service-oriented nature aligns with our mission.”

MD Anderson’s workforce includes many veterans, active duty service members, National Guard members or reservists. Here are the stories of three of these warriors.

Lieutenant Colonel Carilynne Miller, United States Army Reserves

Carilynne Miller served in the U.S. Army for five years, which included a deployment in Iraq. After leaving active duty in 2006 and moving to Maryland, she joined the Army Reserves and had the opportunity to work closely with the Joint Staff at the Pentagon. On the civilian side, Miller was hired by Deloitte as a project manager assigned to the State Department.

In 2011, Miller’s husband accepted a job at an Army base in Italy. She moved with him and transferred her duties to a nearby Army Reserves camp in Germany. After five years, Miller and her husband wanted to be closer to family and decided to relocate to Houston.

Miller joined MD Anderson in 2016 as a project manager in Facilities. Immediately after beginning her career at MD Anderson, she felt a strong connection with other veterans who worked here.

“I hadn’t been on the job a week and someone from the Military Veterans Connection network reached out to ask if they could do anything to help my transition to MD Anderson. I know firsthand, that’s something you can’t find everywhere,” Miller says. “The fact that there’s a network of people who have gone through life circumstances that can help build each other up within an organization is one of the things that stand out about this institution.”

In her current role, Miller uses her expertise building strong teams to provide facilities and operational support to our employees and buildings. She is still a member of the Army Reserves group based in Germany and holds the rank of lieutenant colonel. But instead of spending one weekend a month like typical reservists, Miller spends a week and half in Germany three times a year as an instructor for an Army Major’s course at the Command and General Staff College.

“I know it can be challenge at times, but MD Anderson and my colleagues are so supportive of my role in the reserves,” Miller says. “This is one of the most diverse places you can work. And having veterans like me working here, who have been through different experiences in life and molded to work as a team, brings such value to the institution and how we care for people.”

Former Petty Officer Second Class Keith Harris, United States Navy

Keith Harris served as a yeoman for seven years in the Navy before leaving in 1997. He worked briefly for Union Pacific before landing a position here in Payroll.

Harris has spent 21 years at MD Anderson and currently is an associate business systems analyst in Payroll. He vividly recalls having to manually enter time sheets when he was first hired. He says the clerical skills he honed during his time in the Navy made this work a natural fit for him.

“Being in the Navy helped me develop a strong work ethic and attention to detail, as well the ability to adapt to change,” Harris says. “When I first came here, I was heavily involved in manual payroll processing. But being able to adjust to technological advances in our systems over the years has enabled me to interact with employees more to explain our payroll process and help them really understand their pay.”

Captain Richard Morse, United States Army, Retired

Richard Morse served as a member of the Air Force Air National Guard for 10 years before leaving to pursue a nursing career.

Assigned by a nursing agency to MD Anderson, he became a stem cell transplant nurse.

He returned to the military by joining the Army Reserves, however, and was deployed to a combat zone in Iraq as a company commander in charge of 86 soldiers in 2005.

Next Morse held roles as both an Army training officer and captain before deciding to hang up his military uniform for good in 2011, after 24 years of service.

Today, Morse serves as a program manager for our Nursing Workforce Development team and has worked here for nearly 20 years.

He says he never imagined having the opportunity to renew his civilian career at MD Anderson.

“No one can beat the camaraderie you find in the military, but working here comes close,” Morse says. “I’ve always liked collaboration and teamwork, and I’ve been fortunate to work with some great teams here who know how to tackle challenges with a positive attitude.”

Opening up opportunities

For qualified veteran candidates interested in joining our team, MD Anderson offers targeted employment counseling and an online career tool to help them identify opportunities and translate their military experience to relevant positions.

“These resources help veterans control their development journey and assimilate to the civilian workforce,” says Jamie Bernard, a recruiter in Human Resources.

In addition, MD Anderson’s Military Veterans Connection Employee Network plays an integral role in advancing career opportunities for veteran employees. The network – the first of its kind within the Texas Medical Center – uses proactive dialogue, education and collaboration to increase awareness of our veterans’ presence, achievements and contributions. This group partners with Human Resources and Institutional Diversity to lead veteran advocacy and engagement initiatives.

MD Anderson also participates in the Texas Workforce Commission’s Hiring Red, White & You campaign, which connects veterans with employers in the Texas Medical Center and throughout the state through job fairs and a jobs site. The state agency estimates that there are 1.7 million veterans in Texas, of which 967,000 are working or actively seeking work.

These kinds of dedicated efforts have helped MD Anderson earn a place on Military Times’ list of the nation’s 100 Best for Vets list of employers.

“Hiring veterans who have served our country honorably, respectfully and in special ways is a great opportunity for us to give back to the people who’ve given so much to us,” says Perkins.

A longer version of this story originally appeared in Messenger, MD Anderson’s quarterly publication for employees, volunteers, retirees and their families.

Learn about career opportunities at MD Anderson.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

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