Nearly two decades ago, Deborah Goswitz’s youngest child beat leukemia when he was only 3 through a groundbreaking drug trial at the University of Arizona Medical Center.
When Goswitz was diagnosed with advanced breast cancer last spring, this 61-year-old mother of three knew the aggressive team approach offered by the highly skilled UA medical and surgical specialists was what she needed.
Goswitz knew the Breast Health team at UAMC and the University of Arizona Cancer Center combines the latest research, treatment and experience in the battle against breast cancer. She enrolled in a promising drug trial and underwent a mastectomy performed by Michele Ley, MD, director of breast surgery at the UA Department of Surgery, who removed the cancer in April.
Led by Dr. Ley, the breast program includes surgeons Amy L. Waer, MD, and Rebecca K. Viscusi, MD. The three perform as many as 60 breast cancer surgeries each month. Their ongoing research and participation in clinical trials allow them to provide the most advanced treatment options that can be tailored to the needs of each patient, Dr. Ley said.
Among the trials the UA is participating in is I-SPY 2. After consulting with Dr. Ley, Goswitz enrolled in the clinical trial, which gave her access to a new drug that had just been approved by the Food and Drug Administration days before her diagnosis.
Dr. Viscusi, the site leader for the trial, said, “I-SPY 2 is a collaborative research effort that uses genetic and biological markers from individual patients’ tumors to screen several promising new treatments simultaneously. It allows doctors to quickly determine which treatment path might be the most effective for each patient before surgically removing the tumor.”
“Clinical trials enable patients to get treatments that are not readily available to the entire population,” Dr. Ley said. “Through a trial you can often rapidly get drugs to the market that can help patients rather than waiting for years for results.”
UA breast cancer surgeons expect to expand research and clinical trials under the leadership of noted breast cancer surgeon and researcher Leigh A. Neumayer, MD, the new head of the UA Department of Surgery and the Margaret E. and Fenton L. Maynard Endowed Chair in Breast Cancer Research. Dr. Neumayer will begin her new leadership role Aug. 18.
“A diagnosis of cancer is not a fun journey to be on, but if you have to do it, this is the place,” Goswitz said. “It’s the best care you can get. I love the team approach. You benefit from everyone’s experience.”
One-Stop Team Approach
“The most unique feature of our program is its multidisciplinary approach,” Dr. Ley said. “We work together as a team to find the best treatment plan for each patient. We get them connected very quickly to the most advanced therapies.”
When it comes to breast cancer treatment, no one approach works for all patients, added Dr. Viscusi. “We develop a long-term plan with each patient, working together to develop their treatment plan so they are very involved in the decision making.”
UA provides a “one-stop approach,” with a team of breast surgeons, plastic surgeons, medical oncologists, radiation oncologists, breast imagers, breast pathologists, social workers, a supportive care team and a nurse navigator to help patients navigate the system.
“We get you on the road to what you need faster, and patients know what the plan is very quickly,” Dr. Ley said. “It’s very anxiety-provoking for patients to not have a plan. It helps lower people’s anxiety to continually have updates and have things move along at a quicker place than it would if you were going to six different doctors spread across a large geographical area. If your anxiety is lower, it helps you heal faster.”
With some of the clinical trials, patients receive treatment prior to having the cancer surgically removed to determine which therapy is the most effective in killing the cancer cells.
“We want to see how your cancer responds because there are so many things we don’t understand about it,” Dr. Ley said. “Just throwing medication at you might not be the right thing. By starting therapy with the tumor in place, we can really tailor therapy to the cancer’s response.”
The team also uses state-of-the art tools and technology in the surgical treatment of breast cancer. The UA Medical Center recently approved the use of the PEAK PlasmaBlade in surgery, a new tissue-dissection system that uses radiofrequency.
“It allows you to cut the tissue with less energy and less chance of damaging tissues,” Dr. Ley said. “We have found that it reduces procedure time and may result in fewer wound healing complications. We are really excited about it.”
Sandra Beno-Butterbrodt, 41, was among the first patients at UA Medical Center to have the PlasmaBlade used during her December 2013 double mastectomy.
Beno-Butterbrodt, who was diagnosed with invasive ductal carcinoma, requested that the PlasmaBlade be used in her surgery. As a sales representative for Medtronic, the manufacturer of the device, she had been trained in the PlasmaBlade and was aware of its benefits for patients.
She has been highly involved in decision making since her diagnosis, which she said helped ease her fears during treatment and surgery. “Dr. Ley was my quarterback in all of this,” she said, “The team of doctors, nurses and techs was amazing and supportive. I knew we were all on the same page every step of the way.”
Within a day of diagnosis, Beno-Butterbrodt met with Dr. Ley to determine a plan of action. “When I met her, it was such a good connection. My gut told me I was in really good hands.”
Her cancer was found to have the HER2/neu gene, which over-expresses a protein that tells cells to reproduce. She and Dr. Ley discussed all of the options and chose to do chemotherapy before mastectomy, to be followed by hormone therapy.
“All of these decisions were in my control,” said this mother of four. “There is so much to decide as a patient. You are the one driving this. Ultimately it’s my life. That is when I found my voice.”
And she found her dance. Before surgery, Beno-Butterbrodt and her medical team danced in the operating room to “Fighter,” by Christina Aguilera. See the video here: www.youtube.com/watch?v=qtFWQIMF1zs
Beno-Butterbrodt said the comprehensive, coordinated care at UA has made her journey less stressful. “When you have cancer, the less worrying you have the better your recovery,” she said. “You don’t want any gaps in your treatment. You don’t want to waste any time. The sense of urgency I experienced was so refreshing and so helpful.”
She and her family are thankful for the care at the UA. “After my surgery in December, my mom asked my son what he wanted from Santa,” Beno-Butterbrodt said. “He told her, ‘I already got what I wanted. My mommy doesn’t have cancer anymore.’ ”
Breast Cancer Clinical Trials
The breast surgeons at the University of Arizona Department of Surgery are leading several clinical trials. Among them:
• Surgeons are studying the effects of genes and the estrogen hormone and drug effectiveness. Using pharmacogenomics (the study of how inheritance affects individual differences in drug response), they will examine the genomes of patients with breast cancer before surgery.
• Medical and surgical oncologists are studying the impact of pre-operative endocrine (anti-hormone) therapy in post-menopausal women with breast cancer. The therapy is given with the tumor in place to assess response and better tailor the therapy.
• Starting this fall, UA surgeons and radiation oncologists will study different patterns of radiation therapy and surgery in treating patients with lymph node positive breast cancer who have undergone chemotherapy and surgery. The goal of the study is to determine whether the addition of lymph node surgery and/or radiation improves outcomes for patients who had lymph node involvement before treatment began. These questions will be answered in two different national clinical trials.
• Breast imagers and surgeons are examining the use of multiple guide wires to provide better images to locate the abnormal tissue for removal, leading to less-invasive surgeries and reducing the rate of re-excision (a second surgery to remove more cancer).
For a list of all the clinical trials currently open to breast cancer patients at the UA, please visit http://studies.medicine.arizona.edu/study-categories/breast-cancer.