St. Francis Cancer Treatment Center

Oncology Update09I S S U E

J A N2 0 1 5

Dr. Dron Gauchan • Dr. Doug Clark Dr. M. Sitki Copur • Dr. Ryan Ramaekers

B r i n g i n g t h e b e s t c a n c e r c a r e t o y o u r c o m m u n i t i e s

in this issue• Cancer Treatment Center team

participating in EMPOWER project

• Grant broadens access to clinical trials for St. Francis patients

• Einspahr earns Oncology Nursing Certification

Smoking cessation efforts to expand in Grand IslandSt. Francis Cancer Treatment Center has partnered with the American Lung Association to provide the no-cost Freedom From Smoking® program to Grand Island residents for the past three years. Despite the program’s success, there is still a high-need segment of the population that is being missed.

Many people who need to quit are not ready to do so, and participating in Freedom From Smoking® in a classroom setting may not be a step they are ready or willing to take. For this reason, the Cancer Treatment Center is partnering with Dr. Shu-Ming Wang and the Third City Clinic in Grand Island, which serves low income individuals who are ineligible for health insurance or government assistance. Dr. Wang also said that many of Third City’s patients who need to quit don’t have adequate – or any – transportation to get to and from the Freedom From Smoking® classes.

To bridge this gap and take the next step toward population health management, the Third City Community Clinic (TCCC) Smoking Cessation Project has been established. The goal is to empower TCCC patients and other members of the community to improve their health by quitting smoking. The use of tobacco can lead to multiple chronic illnesses like COPD, frequent respiratory infections and lung cancer. Smokers also tend to have a much higher hospital readmission rate, and a lower success rate with cancer treatment, than non-smokers.

Studies have shown that when a health care provider counsels patients on the need to stop smoking and offers help with smoking cessation, the success rate is much higher than with individuals trying to quit on their own. Therefore, the first step in the Third City project is provider education.

Dr. Wang has helped arranged a free educational event for providers and community members who are interested in learning the best way to discuss smoking cessation with patients and to provide a brief smoking cessation training class for those who are interested. The goal is to piggyback on the established program at the Cancer Treatment Center and the resources provided by Tobacco Free Hall County, and provide a wider range of options for those who are addicted to tobacco products.

The smoking cessation education is part of Pfizer’s “Know Your Health” program. These free training sessions will be held on Jan. 20 at CHI Health St. Francis in Conference Room 3. There will be a session from 7 - 8 a.m. for providers who wish to learn how to advise patients to quit smoking, and second session from noon - 3 p.m. for those interested in a smoking cessation education class.

Dr. Shu-Ming WangThird City Community Clinic

Continued on page 3

The CHI Health St. Francis cancer team is participating in a new quality improvement program for Non-Small Cell Lung cancer (NSCLC) care called Engaging Multidisciplinary Teams to Improve Patient Outcomes With NSCLC using Educational Resources (EMPOWER).

EMPOWER is a national project with academic members from Duke, Texas Tech, Cleveland Clinic, Johns Hopkins, University of Illinois, Harvard Medical School and the University of Nebraska, along with the American College of Chest Physicians (ACCP) and the American College of Physicians (ACP).

The goals of the EMPOWER project are to identify and address barriers in community-based healthcare systems, to collect adequate tissue samples to diagnose and stage non-small cell lung cancer properly, and to treat NSCLC with targeted therapies.

The St. Francis Multidisciplinary Care Team for Lung Cancer includes medical oncologists Drs. Copur,

Ramaekers and Gauchan; radiation oncologist Dr. Clark; surgeons Drs. Luebbe, Schneider and Goering; pulmonologists Drs. Hatoum and Salman; interventional radiologist Dr. Evans; and pathologists Drs. Mleczko, Woodward, Keenportz and Frankforter.

By participating in the EMPOWER project, St. Francis will not only improve its own lung cancer care, but have the opportunity to be on the ground floor of a professional training program that will be further developed and made available to clinicians and institutions beyond those engaged in this specific initiative.

Cancer Treatment Center team participating in EMPOWER project

A Confirmatory, Single-Arm, Phase 2 Study of Blinatumomab, a Bispecific T-Cell Engager (BiTE®) Antibody Construct, in Patients with Minimal Residual Disease B-Precursor Acute Lymphoblastic Leukemia (ALL)

In ALL, minimal residual disease (MRD) is defined as the detection of leukemic cells in bone marrow by PCR or flow cytometry

in the presence of hematological complete remission (CR). Patients with persistent/recurrent MRD after induction therapy have a higher risk of relapse than those with no detectable MRD. Effective treatment of patients with MRD aims to avoid hematologic relapse, reduce MRD load, and provide a bridge to subsequent HSCT. Blinatumomab, an investigational BiTE® antibody construct, redirects CD3+ T cells to CD19+ target cells, resulting in serial lysis of CD19+ B cells. Adults (≥18 years) with B-precursor ALL in hematologic CR (<5% blasts in bone marrow) after ≥3 intensive chemotherapy treatments and with MRD ≥10-3 were evaluated. Patients with current CNS pathology or extramedullary disease, previous allogeneic HSCT, or Ph+ ALL eligible for treatment with tyrosine kinase inhibitors were excluded. Blinatumomab 15 µg/m²/day was

given by continuous IV infusion for 4 weeks, followed by a 2-week treatment-free period (1 cycle). Responders could receive ≤4 cycles of treatment or undergo HSCT after ≥1 cycle. Patients with hematologic relapse discontinued treatment. Rate of complete MRD response (absence of MRD confirmed with a sensitivity of at least 10 4 after 1 cycle) was the primary endpoint. MRD was assessed by allele-specific quantitative real-time PCR for clonal rearrangements of immunoglobulin or T-cell receptor genes by a central laboratory. 116 patients enrolled and received blinatumomab. Median (range) age was 45 (18–76) years; 15 (13%) patients were ≥65 years of age. 35% of the patients were treated in second or later remission. Eighty-eight patients (78%) had a complete MRD response after 1 cycle of treatment. Blinatumomab treatment resulted in complete MRD response across multiple patient demographics including patients in second-line treatment and those with high MRD burden.

Reference: Goekbuget N, Dombret H,Bonifacio M et al. ASH 2014; Abstract 614.

Potentially PracticeChanging Data

Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial

Four previously published randomized clinical trials have shown that tamoxifen can reduce the risk of breast

cancer in healthy women at increased risk of breast cancer in the first 10 years of follow-up. We report the long-term follow-up of the IBIS-I trial, in which the participants and investigators remain largely masked to treatment allocation. Methods In the IBIS-I randomized controlled trial, premenopausal and postmenopausal women 35–70 years of age deemed to be at an increased risk of developing breast cancer were randomly assigned (1:1) to receive oral tamoxifen 20 mg daily or matching placebo for 5 years. Patients were randomly assigned to the two treatment groups by telephone or fax according to a block randomization schedule (permuted block sizes of six or ten). Patients and investigators were masked to treatment assignment by use of central randomization and coded drug supply. The primary endpoint was the occurrence of breast cancer (invasive breast cancer and ductal carcinoma in situ), analyzed by intention to treat. Cox proportional hazard models were used to assess breast cancer occurrence and mortality. The trial is closed to recruitment and active treatment is completed, but long-term follow-up is ongoing. This trial is registered with controlledtrials.com, number ISRCTN91879928.Findings Between April 14, 1992, and March 30, 2001, 7154 eligible women recruited from genetics clinics and breast care clinics in eight countries were enrolled into the IBIS-I trial and were randomly allocated to the two treatment groups: 579 to tamoxifen and 3575 to placebo. After a median follow up of 16•0 years (IQR 14•1–17•6), 601 breast cancers have been reported (251 [7•0%] in 3579 patients in the tamoxifen group vs 350 [9•8%] in 3575 women in the placebo group; hazard ratio [HR] 0•71 [95% CI 0•60–0•83], p<0•0001). The risk of developing breast cancer was similar between years 0–10 (226 [6•3%] in 3575 women in the placebo group vs 163 [4•6%] in 3579 women in the tamoxifen group; hazard ratio [HR] 0•72 [95% CI 0•59–0•88], p=0•001) and after 10 years (124 [3•8%] in 3295 women vs 88 [2•6%] in 3343, respectively; HR 0•69 [0•53–0•91], p=0•009). The greatest reduction in risk was seen in invasive estrogen receptor-positive breast cancer (HR 0•66 [95% CI 0•54–0•81], p<0•0001) and ductal carcinoma in situ (0•65 [0•43–1•00], p=0•05), but no effect was noted for invasive estrogen receptor-negative breast cancer (HR 1•05 [95% CI 0•71–1•57], p=0•8). These results show that Tamoxifen offers a very long period of protection after treatment cessation, and thus substantially improves the benefit to harm ratio of the drug for breast cancer prevention.

Reference: Cuzick J , Sestak I, Cawthorn S et al. Lancet Oncology 2014; http://dx.doi.org/10.1016/51470-20459(14)71171-4.

Potentially PracticeChanging Data

Smoking cessationContinued from cover

In addition to the Third City Community Clinic Smoking Cessation Project, the clinic will also be hiring two full-time community health care workers in order to more effectively help patients navigate the health care system, access community resources and manage their chronic health problems including those related to smoking.

The Oncology Update is now two years old! Thanks to your support and feedback, our newsletter has become a true reflection of the dynamic, upbeat, exemplary team work of the St. Francis Cancer Program.

We are so proud to see so many new accomplishments of our cancer team in every issue along with update of cutting-edge practice changing data. This issue is no different. So many new exciting initiatives, projects and services continually being made available to our cancer patients through an amazing team.

Thank you all for this wonderful teamwork and Happy Second Birthday to our newsletter!

Oncology Update newsletter enters third year of publication

Medical Director of Oncology M. Sitki Copur, MD, FACPManaging Editor Erin Martinez

Grant broadens access to clinical trials for St. Francis patientsSt. Francis Cancer Treatment Center has recently opened 20 new clinical trials, thanks to the NCI Community Oncology Research Program (NCORP) grant that was awarded to the CHI Institute for Research and Innovation (CIRI) in August 2014. Since the time of the award, CIRI has been working to get its regulatory processes and background pieces in place so its sites could take advantage of nearly two dozen new trials.

CIRI is a key member of the oncology research group NRG, which encompasses National Surgical Adjuvant Breast Project(NSABP), Radiation Therapy Oncology Group (RTOG) and Gynecologic Oncology Group (GOG), giving its members access to cooperative trials from those groups as well as Alliance group trials. CIRI is also a main member of Eastern Oncology Group- American College of Radiology Imaging Network (ECOG-ACRIN) and a member of Clinical Trials Support Unit CTSU, which broadens access to a huge variety of clinical trials. In total, CIRI has rolled out 22 cooperative group trials to its member sites, which in Nebraska encompasses CHI Health, including St. Francis Cancer Treatment Center, Good Samaritan Cancer Center, St. Elizabeth Cancer Institute and all former Alegent-Creighton hospitals.

Beginning in November, the research team at St. Francis has been actively screening for the new clinical trials, which include adjuvant breast, metastatic lung, head and neck, leukemia and prostate cancer trials. They have also opened three new pharmaceutical trials and have several more in process. The goal for St. Francis is to accrue as high as it has traditionally done i.e. up to 30% of new cancer cases seen per year. National average is 3%.

To see a listing of all active clinical trials, please visit http://chinebraskaclinicaltrials.org/. The clinical research team at St. Francis includes Rebecca Hadenfeldt, BSN, CCRP; Sarah Einspahr, RN, OCN; Jennifer Scott, BSN, OCN; and Mary Gulzow, CRA, CCRP. If you would like to learn more about the available clinical trials and whether a patient might qualify, the research team can be contacted at (308) 398-6518 or clinicaltrials@sfmc-gi.org.

Hadenfeldt named Clinical Research Manager

Clinical research nurse Rebecca Hadenfeldt has been promoted to Clinical Research Manager, with oversight of the St. Francis and Good Samaritan clinical trials departments. Hadenfeldt’s main responsibilities will be to facilitate communication between sites and with the CHI Institute for Research and Innovation (CIRI), and to help obtain clinical trials to fill the gaps of disease sites that are needed at either facility. Although the position’s main focus is oncology, Hadenfeldt will also oversee other research that is done at both facilities.

Hadenfeldt received her nursing degree from UNMC on the University of Nebraska-Lincoln campus. In the first four years of her career, she worked as a floor nurse at both St. Elizabeth and St. Francis in Med/Surg Oncology and Orthopedics. Hadenfeldt then served as the Education Coordinator at St. Francis for five years before moving to the Cancer Treatment Center’s clinical research department in 2010.

Rebecca Hadenfeldt, BSN, CCRP

A randomized, double-blind, phase III study of Docetaxel and Ramucirumab versus Docetaxel and placebo in the treatment of stage IV non-small-cell lung cancer after disease progression after 1 previous platinum-based therapy (REVEL): treatment rationale and study design

1253 patients with previously treated metastatic Non-Small Cell Lung Cancer (NSCLC) were randomized to receive either ramucirumab (10 mg/kg every three weeks) in combination with docetaxel (75 mg/m2 every 3 weeks) on day 1 of a 21-day cycle (n=628) or matching placebo plus docetaxel (n=625). A statistically significant prolongation of OS was demonstrated [HR 0.86; (95% CI: 0.75, 0.98); p=0.024]; median OS was 10.5 months in the ramucirumab plus docetaxel arm and 9.1 months in the placebo plus

docetaxel arm. Progression-free survival was also significantly longer for patients receiving ramucirumab plus docetaxel [HR=0.76 (95% CI: 0.68, 0.86); p<0.001)]. Safety data was evaluated in 1245 patients who received at least one dose of study drug. The most frequently reported adverse reactions with ramucirumab plus docetaxel (incidence greater than or equal to 30% were neutropenia, fatigue asthenia, and stomatitis mucosal inflammation. The most common serious adverse reactions with ramucirumab plus docetaxel were febrile neutropenia (14%), pneumonia (6%), and neutropenia (5%). The recommended dose and schedule for ramucirumab in combination with docetaxel for NSCLC is ramucirumab 10 mg/kg intravenously and docetaxel 75 mg/m2 intravenously administered every 3 weeks.

Reference: Garon EB1, Cao D, Alexandris E, John WJ, et al. Clin Lung Cancer. 2012 Nov;13(6):505-9. doi: 10.1016/j.cllc.2012.06.007. Epub 2012 Jul 31. Garon E, Ciuleanu TE, Arrieta O et al. The Lancet 2014; http://dx.doi.org/10.1016/S0140-6736(14)60845-X.

Potentially PracticeChanging Data

Optimal method of detection and threshold for early intervention to prevent lymphedema: A multi-center prospective study

For early intervention to prevent progression to lymphedema in patients undergoing axillary clearance, the optimal threshold is 5% or greater

to less than 10% relative arm volume change as measured by perometry. Further, researchers stressed, arm volume measurements are necessary before and after axillary node clearance (ANC) to allow for early intervention. Researchers of this prospective multi-center study compared multi-frequency bioimpedance spectroscopy (BIS, ImpediMed) with the validated perometer method to determine which test is more sensitive for detecting the optimal threshold to prevent lymphedema. They included 960 subjects who underwent axillary clearance at 9 UK centers and had pre-operative and regular arm volume measurements post-surgery (1, 3, 6, 9 and 12 months, then 6 monthly), by the validated arm perometry compared with BIS (L-Dex) measurements as well as self-reported symptoms questionnaire. They calculated change in arm volume using relative arm volume change (RAVC), and assessed the predictors of lymphedema development and optimal method. Currently, researchers have 6-month follow-up data for 612 patients (median age: 55 years; range: 24 to 90 years), and 18-month

follow-up data for 327. Overall, 76% of patients were ER positive and received endocrine therapy, 84% percent received radiotherapy and 67% received chemotherapy in addition to surgery. In 19% of women, lymphedema by 18 months was detected with perometry (10% or greater RAVC), and a change in L-Dex of 10 was observed in 31% of women. Researchers found a moderate correlation between perometer and BIS at 3 months (r=0.40) and 6 months (r=0.60), with a sensitivity of 73% and specificity of 84%.Univariate analysis revealed a threshold for early intervention to prevent lymphedema was RAVC 5% or greater to less than 10% (P=0.03). Upon multivariate analysis, researchers observed that estrogen receptor (ER) negative breast cancer (P=0.01, hazard ratio (HR)=0.43, 95% confidence interval (CI)=0.24 to 0.84), number of positive nodes (P=0.01, HR=1.05, 95% CI=1.01 to 1.09), and a measurement of 5% or greater to less than 10% (P=0.04, HR=1.67, 95% CI=1.03 to 3.54) at 6 months after surgery predicted development of lymphedema. They plan for further investigation of why ER negative patients are at increased risk of developing lymphedema.

Reference: Bundred NJ, Stockton C, Riches K et al. San Antonio Breast Cancer Symposium 2014; Abstract.

Potentially PracticeChanging Data

Lenalidomide plus dexamethasone is a reference treatment for relapsed multiple myeloma. The combination of the proteasome inhibitor carfilzomib with lenalidomide and dexamethasone has shown efficacy in a phase 1 and 2 study in relapsed multiple myeloma. Stewart et al randomly assigned 792 patients with relapsed multiple myeloma to carfilzomib with lenalidomide and

dexamethasone (carfilzomib group) or lenalidomide and dexamethasone alone (control group). Progression-free survival significantly improved with carfilzomib (median, 26.3 months, vs. 17.6 months in the control group; hazard ratio for progression or death, 0.69; P=0.0001). The Kaplan–Meier 24-month overall survival rates were 73.3% and 65.0% in the carfilzomib and control groups, respectively (hazard ratio for death, 0.79; 95% CI, 0.63 to 0.99; P=0.04). The rates of overall response (partial response or better) were 87.1% and 66.7% in the carfilzomib and control groups, respectively (P<0.001; 31.8% and 9.3% of patients in the respective groups had a complete response or better; 14.1% and 4.3% had a stringent complete response). Patients in the carfilzomib group reported superior health-related quality of life. The addition of carfilzomib to lenalidomide and dexamethasone resulted in significantly improved progression-free survival with a favorable risk–benefit profile. Reference: Stewart AK, Rajkumar V, Dimopoulos MA et al . N Eng J Med December 6, 2014 | DOI: 10.1056/NEJMoa1411321, ASH 2014 Abstract 379.

Potentially PracticeChanging Data

Carfilzomib, Lenalidomide, and Dexamethasone for Relapsed Multiple Myeloma

Einspahr earns Oncology Nursing CertificationSarah Einspahr, RN, is the most recent employee of the St. Francis Cancer Treatment Center to become an Oncology Certified Nurse (OCN). This certification is awarded to nurses who pass the certification examination, which is administered by the Oncology Nursing Certification Corporation. The examination tests the knowledge necessary to practice competently in adult oncology nursing, and validates the individual’s specialized knowledge in cancer nursing.

Nine basic areas of competency are tested during the OCN examination, including Health Promotion, Screening and Early Detection; Scientific Basis

for Practice; Treatment Modalities; Symptom Management; Psychosocial Dimensions of Care; Oncologic Emergencies; Survivorship; Palliative and End-of-Life Care; and Professional Performance.

There are currently six other nurses at the Cancer Treatment Center who are oncology certified, including Darla Cleveland, Kelli Eriksen, Vicky Frost, Courtney Fuller, Mary Mickey and Jennifer Scott.

Sarah Einspahr, RN, OCN

Back row (L-R): Kelli Eriksen, Courtney Fuller, Darla ClevelandFront row (L-R): Vicky Frost, Mary Mickey, Rebecca Hadenfeldt, Jennifer Scott

Autologous Hematopoietic Stem Cell Transplantation (AHCT) in Patients with Chemotherapy-Sensitive, Relapsed/Refractory (CSRR) Human Immunodeficiency Virus (HIV)-Associated Lymphoma (HAL): Results from the Blood and Marrow Transplant Clinical Trials Network (BMT CTN 0803)/AIDS Malignancy Consortium (AMC-071) Trial

FDA Hematology/Oncology Drug Approvals

HIV infection is associated with increased risk of non-Hodgkin (NHL) and Hodgkin lymphoma (HL). Historically HIV-infected patients had inferior outcomes and increased treatment-related morbidity and mortality over uninfected patients. Highly active antiretroviral therapy (HAART) improved the prognosis for patients

with HAL and permitted treatment identical to that in uninfected patients. The role of AHCT in HIV-infected patients was investigated by this trial. Patients with treatable HIV-1 infection, age > 15 years, adequate organ function and CSRR aggressive NHL or HL were evaluated by AHCT using the BEAM regimen. HAART was withheld during the preparative regimen and until therapy-related GI toxicity resolved. 43 patients were enrolled; 3 progressed prior to AHCT and were excluded from analysis. Forty patients underwent AHCT (5 female, 35 male). Median age was 46.9 years. Lymphoma subtypes included diffuse large B-cell lymphoma (40%), plasmablastic lymphoma (5%), Burkitt/Burkitt-like lymphoma (17.5%) and HL (37.5%). All patients received < 2 salvage regimens. Prior to transplant, 30 patients (75%) were in complete remission (CR), 8 (20%) were in partial remission (PR) and 2 (5%) had relapsed/progressive disease (RPD). Pre-HCT HIV viral load (VL) was undetectable in 31 patients (77.5%) and detectable in 9 (22.5%) with a median VL of 84 copies/mL. Cumulative incidence of TRM was 5.2%. With a median follow-up of 24 months post-AHCT, estimated probability of one-year OS was 86.6. The cumulative incidence of relapse/progression at one-year post-HCT was 12.5%. Estimated probability of one-year PFS was 82.3% . Patients with HAL may successfully undergo AHCT with favorable outcomes. AHCT should be considered the standard of care for patients with relapsed/refractory HAL who meet standard eligibility criteria.

Reference: Alvaranas J, Rademacher JL, Wang Y et al. ASH 2014; Abstract 674.

Potentially PracticeChanging Data

• Lanreotide (Somatuline Depot Injection, Ipsen Pharma) for the treatment of patients with unresectable, well or moderately differentiated, locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) to improve progression-free survival. December 16, 2014

• Ramucirumab (Cyramza Injection, Eli Lilly and Company) for use in combination with docetaxel for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) with disease progression on or after platinum-based chemotherapy. December 12, 2014

• Ruxolitinib (Jakafi, Incyte Corporation) for the treatment of patients with polycythemia Vera (PV) who have had an inadequate response to or are intolerant of hydroxyurea (HU). December 4, 2014

• Blinatumomab (BLINCYTO, Amgen Inc.) for the treatment of Philadelphia chromosome-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia (R/R ALL). December 3, 2014

• Bevacizumab solution for intravenous infusion (Avastin, Genentech, Inc.) in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan for the treatment of patients with platinum-resistant, recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer. November 14, 2014

• Ramucirumab (Cyramza, Eli Lilly and Company) for use in combination with paclitaxel for the treatment of patients with advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma. November 5, 2014

Kicking the habitSt. Francis Cancer Treatment Center offers free tobacco cessation classes to its patients, and anyone in the community, who wants to quit using tobacco.

The Freedom From Smoking® program was developed by the American Lung Association, and teaches participants how to quit in a supportive setting.

The seven-week, eight-session program is lead by Cancer Treatment Center staff members Ann Tvrdy, MSN, CRNI, and Connie Hameloth, RN, who are both certified facilitators.

“Freedom From Smoking® was developed by a team of physicians, psychologists and health educators,” Hameloth said. “Over the past 25 years, it has been continually tested, updated and improved, so participants can feel confident that they are receiving the best possible assistance from a top-rated program.”

If you have a patient who is interested and could benefit from this program, please contact Ann or Connie at (308) 398-5450 for information on upcoming classes.

C O N TAC T I N F O R M AT I O N St. Francis Cancer Treatment Center2116 West Faidley AvenueGrand Island, NE 68803(308) 398-5450ht tp : / / c h ihea l ths t f ranc i s . o rg /

This newsletter is published by

the St. Francis Medical Center

Marketing and Communications

department. To unsubscribe, please

contact Erin Martinez, Cancer

Communications Coordinator, at

(308) 398-6787 or

emartinez@sfmc-gi.org.

Oncology Update Issue 09 January 2015

Providers:M. Sitki Copur, MD, FACP

Medical Director of OncologyRyan Ramaekers, MD

Dron Gauchan, MDDoug Clark, MDDeborah Nelson, APRN, AOCNPMonica McDonald, APRNJami Kezeor, APRNMegan Schriner, PA

Clinical Trials:Sarah Einspahr, RN, OCNMary Gulzow, CRA, CCRPRebecca Hadenfeldt, BSN, CCRPJennifer Scott, BSN, OCN

Center for Translational Research Alicia Wicht, CRA

Pharmacists:Angie Obermiller, PharmD

Oncology Pharmacy SupervisorJon Olsen, PharmDMark Tharnish, PharmD

Navigators:Courtney Fuller, RN, OCN

Breast Cancer Nurse NavigatorAshley Wissing, MA

Patient Navigator

NutritionistMaureen Hilderbrand, RD, LMNT

Genetic Counselor:Kim Brussow, CGC

Tumor RegistryLeslie Mlinar, CTRPatty Tripp, CTR, RHIT

Patient & Family Counselor:Mary Ann Kalinay, MS, LMHP

Oncology Project CoordinatorAnn Tvrdy, MSN, CRNI

Certified Tobacco Cessation Facilitator

Community Outreach CoordinatorConnie Hameloth, RN

Certified Tobacco Cessation Facilitator

Management:Max Norvell, PharmD

Director of OncologyMary Mickey, RN, OCN

Clinical Manager, Medical OncologyHeather Williams, CMD RTT (R)(T)

Clinical Manager, Radiation Therapy

Meet our team

Cancer Treatment Locations:

St. Francis Cancer Treatment Center2116 West Faidley AvenueGrand Island, NE 68803(308) 398-5450

St. Francis Cancer Treatment Center2nd Street & Marian RoadHastings, NE 68901(402) 461-5588

Visit us online:

http://chihealthstfrancis.org/

St. Francis2620 West Faidley AvenueGrand Island, NE 68803