The Edith Sanford Breast Center Integration and Collaboration for World Class Care
Mar 26, 2017 08:18PM
● Published by Digital Media Director
By Alex Strauss
Even before the Edith Sanford Breast Center opened the doors of its 48,000 square foot facility on the Sanford campus in SIoux Falls this year, it was already on the leading edge of cancer centers nationwide.
This spring, with an eye-catching new space and integrated approach to breast health, including screening and diagnostics, genetic testing and counseling, cutting edge treatments, navigators, an extensive biobank, and clinical research associates in one setting, the center was poised to turn some heads. And turn them, it has.
In February, Cancer Breakthroughs 2020, the world’s most comprehensive cancer collaborative focusing on combination immunotherapy, announced the selection of Sanford Health as one of three sites nationwide to launch the program’s first clinical trial, an immunotherapy vaccine for patients with unresectable or metastatic HER2-expressing breast cancer.
“This first trial is taking the concept of a cancer vaccine and bringing it to patients for the first time in this manner,” says medical oncologist Stephen Powell, MD, a clinical investigator for Sanford Research. . “It utilizes a genetically engineered adenovirus to stimulate an immune response. Essentially, it is teaching the immune system to recognize and attack breast cancer.”
Cancer Breakthroughs 2020 was created in 2016 to facilitate collaboration among multinational pharmaceutical, biotechnology companies, academic centers and community oncologists in an effort to test novel immunotherapy protocols in combination with other treatment methods. The goal is to support the development of an effective vaccine-based immunotherapy to combat cancer by 2020. Sanford Cancer Center, a 2016 recipient of the ICLIO (Institute for Clinical Immuno-Oncology) Innovator Award in recognition of its efforts to enhance treatment options with immunotherapy, has been involved with Cancer Breakthroughs 2020 since its inception.
“We have a reputation of getting these types of trials up and running quickly because we are an integrated health system,” says David Pearce, PhD, executive vice president for Sanford Research. “ This vaccine which will be the next step for patients who haven’t responded to other treatments for this type of breast cancer.”
As immunotherapy plays a larger role in cancer treatment, genetic testing becomes more and more important. Powell says Sanford is ready. “We have a very comprehensive precision medicine program here,” says Dr. Powell, who chairs Sanford’s molecular tumor board. “We provide and review genetic testing on patients with all types of cancer and now have over 60 treatment options for patients who have had this testing.”
The Cancer Breakthroughs 2020 vaccine trial is just one of a dozen breast cancer trials currently underway at Sanford. Some are focused on new therapies while others are exploring new options for symptom control, nausea prevention, risk factors, etc.
“What’s cool is that we get to see results because of these clinical trials,” says Tiffany Facile, Sanford’s Enterprise DIrector of Clinical Research Operations. “When one of our patients receives a grave diagnosis but they are still here talking to us after three years because of a clinical trial, that is very exciting for us.”
Big Data to Guide Treatments
Recognizing that data is empowering, Sanford Health recently became one of the first healthcare organizations in the country to join CancerLinQ, a national nonprofit whose purpose is to provide members with access to real-time patient data to guide cancer treatment. This learning database is comprised of 75 centers (and counting), all of whom are sharing patient data with a view toward tailoring cancer treatments that are, as Sharon Hunt, Executive DIrector Sanford Cancer, says, the “most effective and the least punishing”.
“If I am trying to figure out how best to treat your breast cancer, looking at the global picture of everyone who has been treated this way can be invaluable,” says Hunt. “Our physicians can now go into this database and say, ‘Here is Sharon. Here is everything about her cancer and here are the outcomes that others like her have seen’. Then they can use that data to decide what is next for that patient.”
The project is funded by a grant from the American Society of Clinical Oncology and donations through Conquer Cancer Foundation. CancerLinQ incorporates ASCO’s clinical guidelines and QOPI quality measures - the gold standards for clinical decision making and assessment of quality of care. Sanford Health is the only healthcare system certified by ASCO in their Quality Oncology Practice Initiative in both North Dakota and South Dakota.
In addition to providing a campus “home” for the comprehensive treatment of breast cancer, the Center also houses all of the advanced technology needed to screen for it. The addition of another 3D mammography unit means that more patients can be screened more rapidly. The Center also offers stereotactic biopsy for both prone and upright 3D imagining. Contrast enhanced mammography recently became available and whole breast ultrasound is on its way. (See sidebar for a full list of diagnostic services)
“These different technologies all have their place,” says Hunt. “Again, it is about figuring out the best screening plan for each individual patient. More tools means we can better individualize our screening.”
Even with all the best tools in place, one of the most important features of the Edith Sanford Breast Center is one that can’t even be seen. The Initiative that underpins the work being done here is focused on unravelling the complex genetics behind breast cancer with a view toward prevention, earlier intervention, individualized treatments and, ultimately, a cure.
An example is the national “Women Informed to Screen Depending on Measures of Risk” or WISDOM trial. Through a collaboration with Athena Breast Health Network, a national breast cancer research project, Sanford’s genomic lab will become a repository for specimens collected in a five-year study of personalized breast cancer screening based on genetic testing. The trial will enroll 100,000 consenting women across the US.
“Right now, we try to characterize risk through mammography, but WISDOM adds genetic analysis to that,” says Dr. Pearce. “This is a way for us to get a better idea of who is actually at highest risk, based on more than just breast density.”
“The current guidelines for breast cancer screening are very generalized and outdated,” says Facile. “For a woman who has to have multiple biopsies, the emotional and psychological burden can be very difficult.The WISDOM trial will compare traditional mammography and a more personalized risk-based approach to determine if one is safer or more effective and financially responsible than the other.”
Sanford plans to open enrollment for the WISDOM trial this summer with hopes to enroll more than 20,000 patients. Women aged 40 to 74 who have not had a prior breast cancer diagnosis and receive care at an Athena site like Sanford are eligible to enroll.
Under One Roof
Although many of these collaborations and innovations were underway before the Edith Sanford Breast Center building opened, Hunt says having so many elements of breast health under one roof is a benefit to all patients, regardless of why they have come here.
“Instead of having to work around the way buildings were designed 20 years ago, we were able to take information and ideas and frustrations from patients, families, and clinicians and construct a center that supports breast care delivery models of the future, right now,” she says.
A big part of that model includes the recognition that to be truly effective, breast care must encompass all aspects of the patient and family experience - from diagnosis and screening, through treatment, and beyond. The building welcomes patients with a calming, wood-tone interior but also with evidence of advanced care; the molecular genetics laboratory with its glass front and the breast clinic for high risk women are also right up front.
Importantly, the building is also designed with plenty of “nooks and crannies” to facilitate the integration of research associates into the Center’s day-to-day patient care activities. “Before the building, we didn’t have space for research associates to hang out in the clinical space,” says Hunt. “Now, they are able to interact on a daily basis with our navigators. That physical proximity helps us to generate a team that clicks along and works best for patients.”
Patients who come here for screening enter a different area from those who have been diagnosed. For breast cancer patients, the building features larger exam rooms to accommodate multiple clinicians or family members and conference space where each case can be discussed by a multidisciplinary team. More than 67 commissioned art pieces adorn the walls and patients themselves are invited to express their own feelings in special art creation areas. The Kirby lobby features dedicated computers for breast cancer research and education.
“Cancer is an anxious time and information helps to mitigate that anxiety,” says Hunt. “We have tried to create an environment that is as supportive as possible for patients as they go through this journey.”
Breast Health Imaging Services at Edith Sanford
Low Dose 3D Screening Mammography
Screening/Diagnostic Digital Mammography
Computer Aided Detection (CAD)
Breast Ultrasound Guided Biopsy and Aspiration
Stereotactic Core Biopsy
Pre-op Needle Localization
Breast Specific Gamma Imaging
Regional and Local Mobile Mammography Service
Bone Density Testing
After-Breast-Cancer (ABC) Support Group
Look Good, Feel Better
Edith Sanford Athena Breast Health Program
Sanford Cancer Survivorship Warm Water Exercise
Oncology Care Coordinator - Breast Cancer Services
Comprehensive Lymphedema Program
Genetic Risk Assessment & Counseling
For information on the Cancer Breakthroughs 2020 trial, call 1-87-SURVIVAL