Annual Report 2023
2023 Director’s Letter
and rectal surgeons, otolaryngologists, palliative care physicians, and oral and maxillofacial surgeons. In 2023, three new physicians joined the CI team: J. Nathan Cantrell, MD, Jonathan C. Delong, MD, and Michael L. Winstead, MD, DMD. Our team has grown to include nurse practitioners, physician assistants, genetic counselors, oncology nurses, oncology pharmacists, social workers, dieticians, nurse navigators, patient navigators, radiation therapists, integrative health practitioners and many other health care professionals with our team now approaching 500 members. In 1996, dedicated space for the first multidisciplinary oncology clinic was opened on the sixth floor of the south wing of the medical center. This was the first step in consolidating oncology services for the convenience of the patients and to enhance collaboration between oncology providers. In 2003, the Cancer Institute moved into new space in Medical Building D that increased the clinical space needed for the growing volumes, physicians and staff. This new facility included imaging services providing greater convenience for patients. Volumes and services continued to grow and in 2012, the Cancer Institute moved into a brand new 100,000 square-foot home that further increased clinical space and imaging services in Medical Building F. This move also included the relocation of a new state-of-the-art radiation oncology center in the Cancer Institute. Space continues to be a challenge as patient volumes increase and new programs and services are added such as Oncology Genetics and the Transplant and Cellular Therapy program. With the relocation of the
Greetings to all,
the advancement of the cancer program at the medical center. In 2023, the Cancer Institute (CI) launched a new five-year strategic plan (2023– 2027) outlining a number of objectives to be completed in the areas of patient care, research and education. Our team has begun the hard work to accomplish these goals. With so much still to do, we often do not take the time to reflect on where we have been and what has been accomplished. At the time I joined the medical center, the oncology team consisted of two medical oncologists, one radiation oncologist and as noted above, I was the first surgical oncologist. In support of the healing portion of our three- part mission of healing, education and discovery, our team has grown to include 18 medical oncologists, nine surgical oncologists, four radiation oncologists, three gynecologic oncologists, and two transplant and cellular therapy physicians. In addition to the above physicians, specialists with oncology specific fellowship training include pulmonologists, thoracic surgeons, urologists, neurosurgeons, plastic surgeons, colon
In 1988, nearing the completion of a surgical oncology fellowship at the MD Anderson Cancer Center, I came to interview for a position in the Department of Surgery at the University of Tennessee Graduate School of Medicine (UTGSM) and The University of Tennessee Medical Center. Recruited by Kimball Maull, MD, then chair for the Department of Surgery, I made the decision to join the medical center team being the first and only surgical oncologist in the region. I was charged with developing a surgical oncology practice and advancing the cancer program at the medical center. My goal was to create a cancer program so any person facing cancer in the region did not have to travel to obtain comprehensive, multi- disciplinary care often at the most difficult and vulnerable time in their life. I laid out the vision for the cancer program in a white paper written in early 1989, and we have continued on this path for almost 35 years.
We remain focused on the things that need to be accomplished to continue
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Advanced Orthopaedics Center, which occupied the second floor of Medical Building F, the Cancer Institute moved into this area in 2023 increasing clinic and laboratory spaces to address the expanding needs of patients and providers. The Cancer Institute also began renovations on the fourth floor, which will increase infusion chairs and the oncology pharmacy. Over the years, access to oncology services for patients in the region has been increased by adding services at the UT Regional Health Centers in Sevierville, Lenoir City and Halls. Oncology services have also expanded at other regional sites including Turkey Creek, Maryville and Alcoa. In 2023, the medical center broke ground on a new facility in Blount County that included space for oncology services. The new center opened in June 2024 to better serve our patients in that region. To further provide access and education to those in our community, the Cancer Institute began its first dedicated outreach program in 1996. With grant funding from the Knoxville affiliate of the Susan G. Komen Foundation, the Cancer Institute established the Breast Health Outreach Program. This program remains operational today and provides screening mobile mammography services to women in 19 counties eliminating time away from work, home and family. Free screening is made available to those without insurance. The program, supported by multiple donors and grant funding through the years, provides easy access to breast cancer screening serving approximately 4,000 women annually. Because of these funding sources, two state-of-the art mobile units have been purchased (2005 and 2015). In addition to breast health education and screenings, the Cancer Institute offers free annual prostate screenings in collaboration with
urologists at the medical center. Other free or low-cost screenings (lung, oral, skin, and cervical) have also been offered in the community. Education programs provided by physicians and members of the team are available upon request. The Cancer Institute remains committed and involved in the educational mission of the medical center and UTGSM. In 2022, the Cancer Institute added two post-graduate training fellowships in the specialties of hematology/oncology and hospice and palliative medicine. In 2023, these programs welcomed their second group of fellows. In addition to the fellows, the Cancer Institute provides educational opportunities for medical students, residents, nurse practitioners, nurses and radiation therapists. In collaboration with the University of Tennessee, the Cancer Institute will soon begin a residency in medical physics within Radiation Oncology. Research, or discovery, the third part of our three-fold mission, has continued to expand along with patient care and education endeavors. While the Cancer Institute has for many years offered both National Cancer Institute cooperative group and pharmaceutical-industry sponsored trials, a formal Office of Clinical Trials (OCT) was established in 2014. The OCT provides the support and resources required to negotiate clinical trial agreements and provide dedicated clinical trials coordinators to assist clinicians and patients in initiating and adhering to clinical trial protocols. At any time, the OCT has approximately 50 oncology clinical trials open for enrollment. In 2019 after much planning, the medical center opened the region’s first biobank with oncology being the first specialty to obtain patient consent for the storage of blood, body fluids
Contents 2 Director’s Letter
5 Cancer Committee Chair’s Report
6 Gynecologic Oncology
9 High Dose Rate (HDR) Brachytherapy
10 Patient Story - Cathy
12 Patient Story - Christian
14 Patient Story - Jennifer
16 Patient Story - Larry
18 Oncology Pharmacy
21 Comedy for a Cause
22 Research Opportunities at the Cancer Institute 24 Cancer Prevention and Surveillance
26 Transplant and Cellular Therapy
28 Cancer Institute Fellowships
30 2023 Philanthropic Impact
32 2023 Cancer Statistics
Cancer Institute Annual Report | 3
and tissue samples. The repository of these samples, along with clinical patient information, is a rich source of data supporting current and future research in areas such as genomics and personalized treatments. Another research milestone was the launch of the Bettie and Oscar Bragg Cancer Research Endowment grants. Funds raised from the 2015 “An Evening in Orange” along with many generous donors created an endowment of over $5 million to fund meaningful research on the campus of the medical center and UTGSM. Since 2020, grants have been awarded annually following an application and peer-review process. In 2021, the Cancer Institute joined a consortium of scientists, researchers and clinicians from UTK, ORNL and the medical center to advance and collaborate on oncology-related research across the multiple sites. This collaboration is ongoing, and more detail is provided in this Annual Report. The Cancer Institute has maintained continuous accreditation as an Academic Comprehensive Cancer Program from the American College of Surgeons (ACoS) Commission on Cancer since 1980. As the ACoS has made
additional accreditations available, the Cancer Institute has pursued obtaining these accreditations such as the National Accreditation for Breast Centers achieved in 2011. The Cancer Institute applied for the National Accreditation Program for Rectal Cancers in 2023 and expects a survey to obtain this recognition in early 2024. In addition to these accreditations, the Cancer Institute is also recognized by the American College of Radiology as a Breast Imaging Center of Excellence. The Radiation Oncology program achieved the American Society for Radiation Oncology Accreditation Program for Excellence (APEx) in 2021. Each of these accreditations requires compliance with many standards that emphasize a commitment to safety, dedication to high-quality patient care and a respect for patients’ rights, needs and concerns. When I came to East Tennessee in 1988, I never dreamed that I would spend my entire professional life at the medical center but after 35 years, I am still here. I have had a challenging and fulfilling career that hopefully has improved cancer care delivery at the medical center and throughout the
region. After much thought and with mixed emotions in the fall of 2023, I announced my intentions to retire in December 2024. The medical center leadership is actively searching for a candidate to fill the CI Director position who will continue the great and important work being done at the Cancer Institute to serve those with a cancer diagnosis in our community and beyond. I am humbled and grateful for the many years of help and support from the medical center and UTGSM leadership, physicians, colleagues and the entire team at UT Medical Center and the Cancer Institute. It has been a wonderful, rewarding journey and for that, I will forever be thankful.
John L. Bell, MD, FACS, FSSO Director of the Cancer Institute Professor, Surgical Oncologist
Meet the New Physicians at the Cancer Institute
J. Nathan Cantrell, MD Radiation Oncologist
Jonathan C. Delong, MD Surgical Oncologist
Michael L. Winstead, MD, DMD Oral and Maxillofacial Surgeon
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Cancer Committee Chair’s Report
and Cellular Therapy (TCT) Program in 2021. During 2023, 43 bone marrow transplant patients were treated but most exciting was the administration of the first chimeric antigen receptor T-cell (CAR-T) and tumor-infiltrating lymphocytes (TILs) therapies in East Tennessee by the TCT team. This cutting-edge treatment frontier will allow us to serve an increasing number of patients in our area. In fact, our cancer goal for 2023 was to apply for national accreditation from the Foundation for the Accreditation of Cellular Therapy. This application process is ongoing, and we look forward as this accreditation, finalizing in 2024, will allow us to collaborate with other organizations around the country. We are quite proud of this growth. We also continue to serve our patients experiencing cancer-related lymphedema with advanced prevention and treatment modalities. We remain the only center in the state of Tennessee who offers advanced surgical treatment options for lymphedema, including lymphovenous bypasses and vascularized lymph node transfer. One of our proudest achievements of the year is the opening of our Regional Health Center in Halls, which contains both medical office space as well as imaging services. In the new Halls Breast Center, we were able to provide 2,408 screening mammograms. We also began administering chemotherapy in Halls, even as we continued to see record numbers of patients take advantage of the oncology services at the other Regional Health Centers (Lenoir City and Sevierville) as well as our regional sites at Maryville, Alcoa and Turkey Creek. All of these accomplishments have come about through the coordinated work of our team. This past year, we added three new physicians and two new midlevel providers, as well as new ancillary staff to the ranks, with each of us dedicated to providing world class care to our community here in East Tennessee.
As I reflect on the past year, I remain humbled and awe- struck by the work being accomplished here at The University of Tennessee Medical Center in the treatment of cancer. We continue to provide world-class care across the spectrum of adult cancers, with new frontiers being forged through research, education and clinical care. From a research perspective, we have continued to participate in clinical trials, both internally and externally sponsored, which allows us to provide patients with the most cutting-edge treatment options. In the past year, we enrolled 76 patients into clinical trials. The Bettie and Oscar Bragg Cancer Research Endowment has also funded internal research projects that are focused on a variety of different cancer types exploring innovative ideas to both treat and prevent disease. From an education standpoint, we welcomed our second set of hematology/oncology fellows, in addition to the residents, medical students and ancillary students who rotate regularly throughout the Cancer Institute. They are able to take advantage of the broad spectrum of diseases that we routinely treat in order to gain insight and training in their own career paths. We were also proud to offer the Big Four Cancer Conference this past fall which drew record attendance and offered high level-training and information to our colleagues. From a clinical perspective, though, we probably saw our greatest advancement in the field of transplant and cellular therapy. We successfully launched the Transplant
Jillian Lloyd, MD, MPH 2023 Cancer Committee Chair Breast Surgeon, Section Chief, Breast Surgical Oncology
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Gynecologic Oncology: Changing the Landscape of Cancer Care for Women in East Tennessee
The year 2009 is a well-remembered milestone in the development of the Cancer Institute. With cancer being named as one of the first two Centers of Excellence at the medical center in 1999, intense planning and development of a broad spectrum of cancer services had been undertaken with the program growing steadily each year. One deficit in the growing cancer program and in the community at large was comprehensive, multidisciplinary services for women with cancer of the reproductive organs. Recruitment of a physician to lead the gynecologic oncology service line and develop a robust program was a high priority for the leadership of the Cancer Institute. Although several potential candidates for the gynecologic oncology program had been interviewed, we had not identified a physician with the experience, expertise and a shared vision to lead the development of an advanced gynecologic oncology service line to care for women in the East Tennessee region.
After continuing strategic discussions on the need for these services and leadership, John L. Bell, MD, Director of the Cancer Institute, reached out to a former East Tennessean and colleague, Larry C. Kilgore, MD, for help. At that time, Kilgore served as a professor and the J. Max Austin Endowed Chair in Gynecologic Oncology at the University of Alabama Birmingham (UAB). The university was known for having an excellent Gynecologic Oncology and fellowship training program, and Kilgore was a nationally known surgeon, researcher and professor in the field. Kilgore was invited to provide a visiting professor lecture to the faculty and residents in the OB/GYN Department at UTGSM and to visit the Cancer Institute in May 2009. During his visit, the Cancer Institute leadership provided a tour of the facilities and discussed the vision for growth of the cancer program at the medical center. The need for gynecologic oncologists to provide vital services for women in the region was a top priority discussion item. A few weeks later, Bell and the leadership team had a very unexpected but most welcome surprise when Kilgore indicated that he was interested in
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coming home to Tennessee to build a gynecologic oncology program at the medical center.
Kilgore came from humble roots in Whitwell, Tennessee, and had attended the University of Tennessee Knoxville to earn a BA in Biology. He then attended medical school at the University of Tennessee Health Science Center in Memphis. He went on to complete an internship, residency and fellowship in Gynecologic Oncology at UAB. After completing his fellowship, he was offered a position at UAB where he had an illustrious academic career that included patient care, research and education culminating in Kilgore becoming professor and the Fellowship Director in Gynecologic Oncology. Although Kilgore was on the faculty for 20 years at UAB, he had remained a true and loyal Big Orange fan attending many home and road games with one of his children graduating from UT Knoxville. In October 2009, Kilgore began to build a comprehensive program in Gynecologic Oncology that included state-of -the-art robotic surgery, patient access to clinical trials and training the next generation of women’s health providers. As the sole practitioner in the group, he faced a difficult and challenging year as the number of referrals to the new service grew rapidly. With support from colleagues in surgical oncology and medical oncology, Kilgore was able to meet the increasing demand of services. He immediately began recruiting an associate to join the new division. Kilgore targeted an outstanding physician he helped recruit and train in the UAB gynecologic residency and fellowship programs. In August 2010, Kristopher J. Kimball, MD joined University Gynecologic Oncology. Kimball, an Atlanta native, had attended the University of the South in Sewanee and attended medical school at Vanderbilt University School of Medicine. He then completed his residency and fellowship in Gynecologic Oncology at UAB. Like Kilgore, Kimball was a Big Orange fan and loved the mountains and rivers of East Tennessee. Kilgore and Kimball continued to build a comprehensive, multidisciplinary Gynecologic Oncology program, providing advance treatment techniques such as robotic surgery and multi-modal treatment options for ovary, uterine and cervical cancer patients. Robotic surgery provides a minimally invasive approach resulting in shorter hospital stays, quicker recoveries, less pain and smaller incisions, and has grown from a single robotic platform to multiple units. Kilgore and Kimball brought knowledge and expertise in robotic surgery to the medical center providing new and safer surgical options for women in need of surgery for gynecologic cancers.
Larry C. Kilgore, MD Professor and Chair of the Department of Obstetrics and Gynecology, Division Director for Gynecologic Oncology, Gynecologic Oncologist
Kristopher J. Kimball, MD Associate Professor, Program Director,
Obstetrics/Gynecology Residency, Division of Gynecologic Oncology, Gynecologic Oncologist
The field of Gynecologic Oncology is unique in that the physicians not only perform surgery, but they also prescribe and manage the systemic treatments for these cancers such as chemotherapy, immunotherapy and endocrine therapies. The gynecologic oncologists also serve as consultative and education resources for OB/GYNs and primary care physicians in the region. They also collaborate with the radiation oncologists to provide advanced treatments including high-dose radiation therapies. In the first two years of a formal Gyneoncologic Oncology service, the number of new cases grew by 236%!
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both malignant and complicated non-malignant conditions of the female reproductive system. Their extensive expertise in complex gynecological surgery has been an asset to the medical center service area. In 2023, University Gynecologic Oncology took occupancy of a new practice space on the second floor of the Cancer Institute. The space was designed to meet the special needs of Gynecologic Oncology patients in a comfortable, calming environment. The practice has also expanded services in the region, offering clinics and chemotherapy at the Cancer Institute, Turkey Creek and the Regional Health Centers in Lenoir City and Halls. In addition to expanding their clinical practice, University Gynecologic Oncology has contributed to the educational programs in the Graduate School of Medicine’s Division of Gynecologic Oncology. Kilgore became the Chair of Obstetrics and Gynecology in 2015 and continues to advance educational programs in this department. Kimball and Boone have also taken leadership roles in the residency training program. Kimball was named Program Director of the residency program in 2019 and Chief of Medical Staff in 2021. Boone directs resident didactics and serves on the Medical Student Curriculum Committee. The team has also provided leadership on many other medical center committees, performance improvement initiatives and electronic medical record projects. Kilgore, Kimball and Boone have contributed extensively to the medical center’s research efforts as principal investigators in several cancer clinical trials. Through philanthropic gifts and special events, they have secured funding to support ongoing research efforts. Their passion
Jonathan D. Boone, MD Associate Professor, Division of Gynecologic Oncology, Gynecologic Oncologist
By 2016, the volume of new cancer cases had grown to approximately three hundred annually. It was time again to recruit another associate. Kilgore and Kimball had been monitoring the training and career of another Tennessean, Jonathan Boone, MD, who joined University Gynecologic Oncology in August 2017. Boone, a West Tennessee native and graduate of UT Knoxville, completed medical school at the UT Health Science Center in Memphis, followed by an internship, residency and Gynecologic Oncology fellowship at UAB. The three-physician group has continued to advance care and services for women in East Tennessee for
UT Medical Center Cancer Institute Turkey Creek office and the UT Medical Center Regional Health Centers in Lenoir City and Halls.
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High Dose Rate (HDR) Brachytherapy In 2009, the Cancer Institute (CI) began offering another type of radiation treatment called high dose rate (HDR) brachytherapy. With brachytherapy, a radiation source is placed directly into or next to a tumor to kill cancer cells. Prior to administering HDR, the radiation oncologist and medical physicists work together to determine the best plan to deliver the most appropriate, safe dose of radiation to the tumor site. The procedure involves the insertion of a catheter into the tumor for several minutes under the direction of the radiation oncologist. Treatments are administered in multiple doses, either once or twice daily or once or twice weekly. HDR may be used in conjunction with surgery, chemotherapy, external beam radiation therapy or a combination of these. The HDR program at the Cancer Institute was initiated in collaboration with the gynecologic oncologists to treat cervical, uterine or vaginal cancers. HDR can also be used to treat skin, breast, lung and prostate cancers. At the Cancer Institute, cases are reviewed at one of the seven multidisciplinary tumor conferences attended by an entire team of oncology specialists, nurse practitioners, pharmacists, genetic counselors, clinical trials coordinators and others to determine the best treatment plan for each patient. HDR is just one of the many different treatment modalities considered when the team makes individualized treatment recommendations.
along with grateful patients resulted in the creation of Comedy for a Cause in 2014. The annual event was initiated to raise awareness of gynecological cancers and raise dollars to support gynecologic oncology research funds. In addition, the practice has completed and been awarded four different research grants from the Bettie and Oscar Bragg Cancer Research Endowment beginning in 2020. Physicians referring patients to University Gynecologic Oncology can be assured of easy access to quality services for their patients. Advanced practice providers, nurses and patient navigators are available to assist with the referral process and support patients and families through their journey. Women in East Tennessee diagnosed with a gynecologic cancer now have an option to receive advanced care with compassion and dignity close to home. And you can bet on any fall football Saturday, the trio will be there cheering on the Big Orange.
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Patient Story: Cathy
At the Cancer Institute, we witness incredible stories reflecting the courage, hope and resilience of cancer survivors every day. Today, we share the remarkable journey of Cathy Rhodes whose long battle began more than 10 years ago when she first noticed pain in her abdomen. After consulting with primary care and GI doctors who identified no problem, the situation then escalated when she noticed some bleeding. “They didn’t know what kind of problem it was. Maybe it was Irritable Bowel Syndrome?” Cathy said. “Honestly, I ignored it the first time. I didn’t want to go back to the doctors.” When the bleeding occurred a second time, however, Cathy sought the counsel of a gynecologist who ran tests and delivered a diagnosis of Stage 1 uterine adenocarcinoma — a type of cancer that develops in the glands that line internal female organs. Soon afterward, Cathy had surgery to remove the cancer and eight lymph nodes. At the time, she was told that all the cancer was gone and she would have no more problems. Three months later, however, the cancer had come back, more aggressive and bigger than it was before. At that point, Cathy turned to Larry Kilgore, MD at University Gynecologic Oncology. He recommended a “sandwich” treatment plan, consisting of four chemotherapy treatments, followed by 20 radiation treatments and concluding with four more chemotherapy treatments — all over the course of seven months. After meeting him, Cathy felt that seeking treatment under his care was the right thing to do. “I’m kind of a Pollyanna,” Cathy said. “I don’t think anything bad is ever going to happen. But you know, you just put your head down, hold your breath and get through it.” When her treatment plan ended, Kilgore informed Cathy that she still had a lymph node with a high radioactive count, and her medical team recommended that it be
treated with stereotactic body radiation on the CyberKnife. This non-invasive treatment delivers a high dose of precisely targeted radiation to destroy tumors. Cathy was also prescribed Avastin, an infusion treatment that helps stop the cancer from growing but doesn’t kill it. “By this time,” Cathy said, “I knew I needed to participate more in my survival.” Cathy calls herself a treasure hunter, and the treasure she sought in this case was information. She embarked on a journey of research and proactive engagement, embracing both traditional and holistic treatments. She integrated dietary changes and mental health practices into her regimen, and she gave up all alcohol. “I took responsibility for things I could control, like my diet,” Cathy said. “I had to ask myself, ‘What was it about my body that was hospitable to cancer?’ There is the ‘seed’ (the cancer cell) and the ‘soil’ (the environment of my body) in which it grew. Dr. Kilgore was focused on the seed; it was my job to address the soil. That was a turning point for me.” “A few months later, I had my first clean scan,” Cathy said. “The cancer was gone, and it never came back again. I believe the CyberKnife treatment and my super clean diet are what made the difference.” Now 69, Cathy and her husband Owen are retired and enjoy traveling and camping in their RV. They also volunteer — helping with visitor services with the National Parks Service — and have worked for three to four months at a time in parks like Bryce Canyon in Utah and San Juan Islands in Washington State. “Cathy has been a valiant and inspirational patient,” said Kilgore. “She is inquisitive and makes informed decisions but is not averse to trying new strategies. Hers has been a journey with quite a few bumps and bruises, but she is a survivor.”
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Patient Story: Cristian
In recognition of Pancreatic Cancer Awareness Month in November 2023, we shined a spotlight on Cristian who — more than four years after his surgery and treatment for pancreatic cancer — continues to thank the Cancer Institute daily. Cristian, who retired from his job as a Distinguished Scientists from a national laboratory, is originally from Romania but has been living in the United States since 1990. In 2019, while still working full time, Cristian’s workload was so busy that he didn’t notice the first signs that something might be wrong. When his son told him that his face was yellow, he wanted to ignore it and blame it on being tired, but his wife insisted that he see their primary care physician. After concerns with the results of an MRI, Cristian was referred to a gastroenterologist, who confirmed that Cristian had cancer. Fortunately, it was operable and the position of the cancer on the pancreas gave the surgeons a reason to be optimistic, so he was scheduled for surgery with James McLoughlin, MD the following week. Acting that fast was essential for limiting the spreading. “I was concerned, but I knew I needed to follow instructions and put my faith in the years of experience and knowledge of the doctors at the medical center,” he said. After surgery, Cristian stayed at the medical center for almost four weeks where he said the doctors and nurses did everything possible to take good care of him. “What impressed me most was the collaboration among
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Cristian and his wife, Adriana
departments — from oncology and chemotherapy to radiology and physical therapy — I had a whole team,” he said. Once he was allowed to go home, Cristian received radiation treatments almost daily for two months. Then, chemotherapy treatments began in early 2020 — every three weeks for a total of six sessions. That period of treatment was difficult, as he lost his hair and 30 pounds. His treatment was ongoing during the COVID-19 pandemic. “I was installed there in a chair for 4-5 hours at a time,” he said. “Even though we were all masked, I felt the support of everybody. I could see it in their eyes — their sympathy, encouragement and continuous support for me.” He added that he also received unlimited support from family, friends, coworkers and neighbors. Today, Cristian continues to live cancer free and enjoys taking cruises with his wife, Adriana, who was a constant source of strength and solace during his cancer journey. After retirement, he continues consulting activity in his own science field. For anyone else facing a similar diagnosis, he has three pieces of advice: “Be humble. Keep optimistic. Trust the capacity, knowledge and progress of science and the medical field.”
“Be humble. Keep optimistic. Trust the capacity, knowledge,
and progress of science and the medical field.” - Cristian
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Patient Story: Jennifer Oncology Genetic Counseling: Is Cancer in your Genes?
Erin Campbell, MS, CGC and Jennifer Rolen. Photographed by John Black.
While some of the first genes associated with cancer risk were identified in the early 90s, great strides have been made in the identification of genes associated with cancer risk in the last 30 years. There have also been significant improvements in the technology available for genetic testing and treatment related to these mutations. Initially, testing was performed to identify a reason why cancer was happening in a family. However, hereditary genetic testing has become a more integral part of cancer care. We now know that genetic testing results can impact the type of surgery a patient undergoes as a part of their cancer treatment, as well as the types of therapy a patient might receive. As highlighted in the feature on High-Risk Gastrointestinal Surveillance Clinic (p. 24), results can also greatly impact a personalized care plan to manage future cancer risk. Genetic testing with a genetic counselor at the University Genetics Oncology Clinic can be a powerful tool for personalizing medical care. A genetic counselor is a specialized medical professional who offers support through genetic counseling. Genetic counseling is a process of providing information and support about genetics and inherited conditions to an individual or family. The goal of
Cancer is a common disease, and, in most cases, it isn’t hereditary. However, for some families it feels inevitable. For Jennifer Rolen, cancer seemed inescapable. “My mother’s side of the family has a history of women who have had ovarian or breast cancers,” she said. This family history led Jennifer’s mother to pursue genetic testing and receive a diagnosis of a BRCA2 mutation. Before her mother’s death, Jennifer’s mother, gynecologist and primary care provider encouraged Jennifer to pursue genetic testing. “I was afraid to do it. I didn’t know if I wanted to find out whether I had won or lost the ‘genetic lottery,’” she said. However, she bravely scheduled a consultation with Erin Campbell, Oncology Genetic Counselor at the University Genetics Oncology Clinic, to discuss her options in more detail. Approximately 10 percent of cancer diagnoses are due to an inherited genetic mutation, like the BRCA2 mutation in Jennifer’s family. People who inherit one of these gene changes will have a higher risk of developing cancer at some point in their life. Genetic counseling can help people understand this risk.
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genetic counseling is to provide clear and clinically relevant information about genetic risk factors in a way that both supports and educates. This is illustrated well by Jennifer’s own journey with cancer genetic testing. “After her first genetic counseling appointment, Jennifer was not emotionally ready for genetic testing. We mutually agreed to schedule check-ins, including one that fell right after her mother’s death due to biliary cancer,” said Erin Campbell, MS, CGC. Jennifer said, “I was an emotional wreck, but Erin has a wonderful way of making me feel safe, even when we talk about terrifying topics. We agreed that I needed further counseling before I was ready for testing. It took two years before I was able to do the tests Erin recommended.” Thankfully, Jennifer tested negative for her mother’s mutation and has been released from many of her fears. “It was the news that I had spent so many years hoping for, but not believing it could happen. I felt free of my family’s curse, and more importantly, that my daughters would be too. Even before I got my results, I was aware of the profound impact Erin had on my life. I don’t think I would have had the courage to get tested without Erin’s unwavering support. Without her care and compassion, I would still be living in the fear of the unknown.” Genetic testing is typically done via blood or saliva sample. Genetic testing is often nuanced and dependent upon a patient’s own health history and their family history. Our oncologists frequently order genetic testing for patients undergoing cancer treatment. All patients with a positive genetic testing result have the option to follow up with a genetic counseling consultation to discuss what these results mean for them and for their family members. Patients who seek genetic testing due to a family history of cancer are also recommended to see a genetic counselor. As noted in Jennifer’s story, a genetic counseling consultation doesn’t obligate patients to testing but seeks to empower patients to make the best medical decisions based on the information we have available. “The goal of my clinic is threefold,” said Campbell. “I want to ensure that the right patient gets the right treatment options based on their genetic testing results. I want to be as proactive as possible moving forward for my patients and their family members. And I want to support patients and meet them where they are.” Patients and providers can call 865-305-4726 (GRAM) to schedule an appointment with the University Genetics Oncology Clinic.
Jennifer Rolen. Photographed by John Black.
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Patient Story: Larry
“I will be grateful to her for the rest of my life,” said Linda Trotterchaud about Veera Motashaw, DO, the palliative care physician who helped her husband, Larry, during his battle with cancer. “God sent an angel to care for me,” Larry said as he began treatment with University Palliative Care. On October 21, 2022, Linda and Larry celebrated their 55th wedding anniversary. “That was the same day we got the diagnosis,” Linda said. “Stage 4 pancreatic cancer that had spread to his liver.” Larry mentioned to his doctor that he had some pain beneath his belly button, and the doctor scheduled an ultrasound. After several additional scans, his cancer was diagnosed. “I now know that no symptoms with this type of cancer is typical. That’s why it’s called a silent killer,” Linda said. Larry immediately began treatment at the medical center. “It was rough. We made 43 trips from Powell over four-and- a-half months,” Linda said. Early on, Larry was weakened by chemotherapy-induced hiccups that were constant over a four-day period. Then, a nurse practitioner referred Linda and Larry to Motashaw. “She did a manipulation with her hands on his diaphragm. It stopped the hiccups and he never had another,” Linda said. A week later, Motashaw and her team took over managing Larry’s pain, anxiety, nausea and side effects from the medications. Like many who have never dealt with a serious illness before, Linda wasn’t familiar with palliative care. “I didn’t even know it was an option,” she said. “What led us to it was Larry’s comfort zone. By that, I mean he could find no comfort.” By concentrating on quality of life, palliative care is designed to enhance a patient’s current treatment and provide relief from pain. Motashaw worked with Larry’s oncologist, radiologist and other specialists to prolong his life as the disease rapidly progressed. In March 2023, Larry wanted to go to Florida to see friends, as he and Linda had done every winter for years. Linda was skeptical. “I said, ‘Larry, I’m unsure about this. You’re awfully sick,’”. But Motashaw put her at ease and encouraged her to take Larry on the trip. So they headed to St. Augustine for a week, along with a nurse Linda hired to travel with them. “Our friends in Florida gave him a huge welcoming party,” she said. “He was so weak, but they were so great to him.”
Larry visited the medical center for palliative care with Veera Motashaw, DO
A couple of weeks after they got home, Linda and Larry came to the medical center for another treatment when they learned that part of his liver had shut down. “Dr. Motashaw said to Larry, ‘I want the very best for you. There’s no reason for you to come back to the medical center. Hospice can come to you. They can treat you just like I’ve treated you,’” Linda said. “If Dr. Motashaw hadn’t been involved, I’m not sure he would’ve done this. He would’ve suffered through more treatments. That’s my husband.” On April 9, 2023 Larry passed away, leaving behind two children, four grandchildren, four great-grandchildren and Linda. “Larry would have lived two months with no treatment. He made it five and a half months with treatment,” Linda said. “I knew in my heart of hearts that I
| Cancer Institute Annual Report 16
had to do everything I could do for him because we didn’t have much time left.”
Looking back, Linda has much to reflect upon. “I learned that to be a good caretaker, you need to take care of yourself, too” she said. Researching treatment options is key also. “I’m so happy to say that I think Larry got the best care available anywhere. I checked into other options. Based on his diagnosis, we were right where we should have been,” she said. While Linda, her family and Larry’s friends have their own memories, Linda will make sure her husband’s legacy continues through an annual scholarship golf tournament with the Teamsters that he started. “We’ll keep that up. We raised $50,000 this year for students who need help going to college,” Linda said.
Cancer Institute Annual Report | 17
Oncology Pharmacy: Dedicated to the Safety and Care of Cancer Patients
medications and managing inventory. Oncology pharmacy technicians at the medical center are specially trained to prepare chemotherapy drugs using methods that maintain medication safety and integrity for the patient while preventing exposure of chemotherapy agents to the remainder of the health care team handling and administering these medications. The oncology pharmacies located within the Cancer Institute and Lenoir City Regional Health Center process and dispense all infused cancer care medications for the health system. This occurs in state-of-the-art cleanrooms where room temperatures, pressures and humidities are monitored every 10 minutes to ensure the highest integrity of medications dispensed to patients. The redundancy in these pharmacies allows for seamless patient care in the event of an unexpected downtime.
The Cancer Institute’s Oncology Pharmacy team is comprised of over 25 pharmacists and technicians representing a broad range of expertise and levels of practice, skills and responsibilities. They play an important role in the delivery of care for individuals living with cancer and are often found behind the scenes throughout the health care system. Oncology pharmacists are involved with the care of cancer patients at many phases of their treatment. They work with other care providers to ensure a current and accurate patient medication list, aide in the selection of the most appropriate therapies, monitor the effects of medications prescribed and assist in management of the adverse effects that often accompany cancer treatments. As the care of cancer patients is challenged with many new medications, high-cost therapies, medication shortages and regulatory requirements, the oncology pharmacist is heavily engaged in supporting the clinical team in their efforts to improve overall cancer care and patient quality of life. Pharmacy technicians work under the supervision of licensed pharmacists and assist with a variety of functions, such as preparing medications for dispensing, performing pharmaceutical calculations, delivering
Patient safety is at the forefront of the oncology pharmacists’ responsibilities. These specialized
pharmacists are an integral part of the multidisciplinary team within the Cancer Institute and are responsible for the continued development of electronic order sets for cancer regimens used in patient treatment. Along with their clinical colleagues, they draft all components of the regimens, that includes the cancer medications, supportive care medications, and laboratory requirements needed for patient monitoring to treat cancer patients timely, safely, and appropriately. Each regimen is reviewed by an oncology pharmacist three times before implementation, in addition to reviews by the physician, nursing and IT team. At the Cancer Institute, a pharmacist leads the multidisciplinary Oncology Pharmacy & Therapeutics Subcommittee, making formulary recommendations on the efficacious, safe and cost-effective use of oncology and supportive medications. In addition to their presence within the pharmacy, the medical center staffs oncology pharmacists on the inpatient oncology unit and within the Transplant and Cellular Therapy program.
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Example of a “Day in the Life” of a UT Medical Center Inpatient Oncology Pharmacist Specialist
Review all patients who were admitted
• Review laboratory data, diagnostic data, medical specialist notes, nursing notes and concurrent medications for appropriateness and potential medication-related problems (e.g., potential drug interactions, dose adjustments for organ dysfunction). • Provide new medication-change recommendations to physicians and advanced practice providers.
Round with the team
• Answer drug information questions. • Provide new medication-change recommendations based on the team’s discussion of each patient.
Compose and review new chemotherapy orders
• Review laboratory data, diagnostic data, medical specialist notes, nursing notes and concurrent medications for appropriateness and potential medication-related problems (e.g., potential drug interactions, dose adjustments for organ dysfunction). • Provide medication-change recommendations to the team.
Provide medication-related services to all inpatients
• Verify all medication orders entered by health care practitioners. • Modify therapy for institution-related medication protocols (e.g., adjust doses of medications when renal dysfunction is present). • Perform medication reconciliation. • Perform discharge medication counseling (use, side effects, etc.). • Arrange for pharmacy to fill prescriptions at time of discharge in an effort to have the patient leave the hospital with medications in hand.
Finally, almost all oncology pharmacists at the medical center are board certified. In addition to their pharmacy education and state licensure, they have completed two additional years of formalized training (a pharmacy practice residency and oncology residency) and passed the Board of Pharmacy Specialties accredited Oncology Pharmacy certification exam. Within the East Tennessee region, the large team of board-certified oncology pharmacists is unique to the medical center, demonstrating our strong commitment to high quality patient care and safety.
CI patients with any medication-related questions can ask to speak with an oncology pharmacist during their infusion treatments. A member of the team is always available to speak with patients and their caregivers.
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Oncology Pharmacy Residency
In 2023, the medical center graduated its inaugural Oncology Pharmacy Residency class of two students. Additionally, the program obtained national accreditation from the American Society of Health-System Pharmacists. An oncology pharmacy residency provides licensed postgraduate pharmacists advanced clinical training that is more focused and rigorous than typical professional practice. Members of the inaugural class, Natalie Hurst, PharmD, BCOP and Ashley Mull, PharmD, BCOP, have become integral members of the Cancer Insitute’s pharmacy team, obtaining oncology pharmacy board certification and remaining part of the team after graduation. The Oncology Pharmacy Residency program relies heavily on oncology pharmacists, oncologists, advanced practice providers and nurses dedicated to teaching during clinical practice. Oncology pharmacy residents at the medical center provide patient care not only in the same settings as oncology pharmacists, but they also practice within physician ambulatory clinics, allowing for more face-to-face patient interaction. Integration of resident pharmacists in the clinic has increased efficiency of patient care between CI physician offices and the infusion centers. It has also provided patients access to the same level of oncology pharmacist care for those receiving oral cancer medications in the ambulatory setting. The Oncology Pharmacy team sincerely appreciates the Cancer Institute’s practitioners and nurses for their important contributions to the Oncology Pharmacy Residency program.
Natalie Hurst, PharmD, BCOP
Ashley Mull, PharmD, BCOP
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Comedy for a Cause
In 2014, the Cancer Institute held the first Comedy for a Cause which was created to raise awareness of gynecologic cancers and to support gynecologic oncology research funds. Comedy for a Cause is a special event to recognize and celebrate survivors of gynecologic cancers and to remember those who have lost their fight. Each Comedy for a Cause event kicks off with great fellowship, food and drinks followed by our team of talented gynecologic oncologists providing some facts and figures about gynecological cancers and the progress being made in treating these cancers. The main event is a stand-up comedy act bringing a positive message along with much laughter. The inaugural event featured Leanne Morgan who entertained the group with her wit and down-
home humor about motherhood and real life. Since 2014, Leanne has returned several times to entertain the group as well as comedian Karen Mills who is also an ovarian cancer survivor. Comedy for a Cause is such a popular event that it has continued to move to larger venues and has experienced sellout crowds in recent years. During the first 10 years of the annual event, Comedy for a Cause raised over $315,000 to support dedicated gynecologic oncology research efforts at the Cancer Institute. The Gynecologic Oncology and Philanthropy teams remain grateful and humbled by the patients, sponsors and other supporters of this uplifting event.
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The ONE UT Collaboration Offers Exciting New Research Opportunities
In 2022, Cancer Institute Director, John L. Bell, MD, met Brad Day, PhD, Associate Vice Chancellor for Research and Innovation Initiatives at the University of Tennessee, Knoxville. Day develops new, cross-disciplinary research activities through ORIED (Office of Research, Innovation and Economic Development). His work supports the university’s strengths, grows collaborations and helps our region leverage that collective expertise to improve lives.
Day’s focus on Health and Human Wellness has provided a foundation for the work he and Bell have done to partner to grow a community of physicians, researchers, scholars and educators. They have connected the medical center with more than a dozen colleges at the university, including Arts and Sciences, Nursing and Education. In addition, they collaborate with Oak Ridge National Laboratory, the University of Tennessee Health Science Center, the
“In all the years I have been at the Medical Center, I have never been more optimistic about our ability to make meaningful research contributions that will positively affect the health of the citizens of Tennessee.” –John L. Bell, MD
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