Dr. Carlos Arteaga with research advocates, Pam Martin and Lynne Cargen (left to right).

As a 15-year breast cancer survivor, Lynne Cargen continues her fight against cancer as a research advocate at Vanderbilt-Ingram Cancer Center. She works with Carlos Arteaga, M.D. and his team of researchers in the Specialized Program of Research Excellence (SPORE) in Breast Cancer.

Cargen said that she has been committed to raising awareness and becoming an advocate for breast cancer since her diagnosis in 1996. “Dr. Arteaga’s invitation to become an advocate in the Breast SPORE provided me with the opportunity to direct my passion as a cancer advocate directly toward the research process,” she noted. “As a research advocate, it is the shared goal to partner with scientists to add the survivors perspective to the research process.”

Cancer survivors are not the only individuals participating in the Cancer Center’s research advocacy program. Caregivers, family members, health professionals and community members are also contributing to the research process and outcomes for future patients.

There are three main objectives for those participating as a research advocate. First one is to provide Vanderbilt-Ingram’s researchers an expanded perspective, since the research advocates are the ones who have personally experienced or been touched by cancer. Second is to help refine the nature of research questions, improve the choice of research tools and enhance outcomes so that research is meaningful and relevant to patients. The last objective is to assist in the development of patient oriented resources and tools for clinical trials.

For those interested in becoming research advocates, Cargen encourages you to educate yourself about your disease and the research process. “Through building education programs and reaching out to the community, we hope to dispel many of the myths of clinical trials and research.”

Please contact Jane Kennedy, manager of patient advocacy, at 615-936-1072 to learn more about Vanderbilt-Ingram’s research advocacy program.

These programs are intended to expand primary and specialty clinical services in Davidson, Maury, Robertson and Williamson counties, while at the same time augmenting specialty training and clinical research.

As a first step, the affiliation agreements create immediate opportunities for all partners to broaden the scope of health care delivery across Middle Tennessee with a broad array of services including, but not limited to, cancer care, primary care, cardiovascular services, diagnostic imaging services, ambulatory surgery and medical facility development.

“We consider each institution to be strong and natural partners as we further our efforts to serve the patients of this region,” said C. Wright Pinson, MBA, M.D., deputy vice chancellor for Health Affairs and CEO of the Vanderbilt Health System.

“We are pleased with the opportunity to formalize our already collaborative relationships with colleagues at Maury Regional Medical Center, NorthCrest Medical Center and Williamson Medical Center. We believe the patients of Middle Tennessee will benefit from an enhanced level of integrated care, ultimately making a significant contribution to health care delivery in our respective communities.”

The agreements ensure all organizations will remain independent while continuing to meet the needs of the communities they serve. Each party can continue to pursue individual initiatives. However, the agreements provide the necessary structure for all parties to form collaborations that will create more efficient, cost-effective patient care through new programs and services, and through the ability to eliminate overlapping and competing projects.

“This expanded affiliation with Vanderbilt will benefit Maury Regional by collaborating with one of the most respected teaching and research hospitals in the nation,” said Robert Otwell, chief executive office for Maury Regional Medical Center. “We can draw upon their clinical expertise and physician recruitment strengths while maintaining our independence as a community hospital.”

Otwell also said the affiliation enhances the capabilities of all four organizations “while advancing health care by offering new services, standardizing best practices and providing the highest value.”

Currently, Maury Regional and Vanderbilt share partnerships through the physician practice of Vanderbilt Heart-Columbia, diagnostic imaging services in Spring Hill and the provision of inpatient neonatal intensive care and cardiac surgery services.

As the nation calls for improved quality of care at lower cost, academic medical centers must identify better ways to best serve patients throughout the continuum of care by creating improved access and cost-effective care delivery systems, said Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of the Vanderbilt University School of Medicine.

“Major developments are occurring rapidly within the delivery of health care as the result of the advancement of medical science. At the same time, changes to federal and state health policy are promoting the creation of innovative models to more efficiently and effectively coordinate the delivery of health care across broad populations.

“These affiliations are a tremendous positive for all parties, serving as a forward-thinking approach to partnerships between community-based hospitals and large tertiary referral centers performing specialty care, training and research,” Balser said.

Going forward, better health management across broad populations will involve the formation of regional partnerships between hospitals and physicians who are committed to: the cost-effective delivery of medical services; establishing medical records connectivity; establishing protocols and incentives for delivering services at the most cost-effective location; jointly building service capabilities and quality programs through these partnerships; and introducing protocols that operationalize evidence-based medical practices.

“As the landscape of health care changes, it becomes increasingly important to find ways to deliver world class care while remaining cost-effective,” said Scott Raynes, president and chief executive officer of NorthCrest Medical Center. “Broadening NorthCrest’s availability of resources through this partnership is one way we can enhance our services, continue our high quality care and remain good stewards of our organization and our community’s health.”

The affiliation puts into place the immediate ability to form jointly operated programs between NorthCrest and VUMC in the areas of cardiovascular services, radiology/imaging, endocrinology, urology, rheumatology and other clinical specialties as well as to partner on educational programs and clinical research.

“This affiliation will enhance the care and services NorthCrest provides to our patients and community through broadening clinical integration with Vanderbilt Medical Center, one of the world’s best academic medical centers,” said Raynes. “Health care is changing daily and this affiliation will help NorthCrest better navigate these changes.”

VUMC and Williamson Medical Center already share longstanding partnerships across a number of services. Vanderbilt’s Williamson County physicians refer patients to Williamson Medical Center for surgical procedures and other inpatient services.

“Amid changes in health care on a national scale, Williamson Medical Center is excited to more formally align itself with the outstanding tertiary services and expertise of Vanderbilt,” said Dennis Miller, FACHE, FHFMA, Williamson Medical Center’s chief executive officer.

“The community will surely benefit as we work side by side with Vanderbilt to fulfill WMC’s mission to meet the health care needs of the communities we serve.”

“While these agreements are focused on the joint creation of new programs with our colleagues at these institutions, we are appreciative of the opportunity for Vanderbilt to continue to strengthen our relationships with the many physicians and hospitals already partnering with us to provide outstanding health care throughout the region,” said Pinson.

Vanderbilt-Ingram Cancer Center’s new clinic is located at 3810 Bedford Ave., behind the Mall at Green Hills. (photo by Steve Green)

Vanderbilt-Ingram Cancer Center has opened a free-standing cancer clinic in Green Hills to give cancer patients more options for their oncology care.

VICC Green Hills provides many of the same services available at the main VICC campus, including access to board-certified cancer physicians and specially trained oncology nurses and pharmacists.

Patients can see an oncologist, have their laboratory tests performed and receive their chemotherapy all in one location.

Chemotherapy drugs are prepared onsite in the specially equipped pharmacy to reduce the amount of time patients spend waiting for drug infusions.

Patients who receive their care in the Green Hills facility are eligible for enrollment in clinical research trials available at VICC.

“At the new VICC Green Hills clinic we are providing the same high-quality standard of care that our patients have come to expect in all of our VICC cancer facilities,” said Michael Neuss, M.D., chief medical officer for VICC.

“We are committed to reaching out to a wider community so that we can bring our expertise and access to clinical research trials to patients in the most convenient setting possible.”

VICC’s new Green Hills clinic features a large waiting room, six patient exam rooms and 11 chemotherapy chairs. (photo by Steve Green)

The new clinic was designed and built to be environmentally sensitive. The LEED-certified space is decorated in relaxing shades of blue and green with earth-tone accents and features a large, open waiting room, six patient exam rooms and 11 chemotherapy chairs.

The chemotherapy infusion area includes communal space as well as chairs with more privacy.

The clinic also features physician offices, team work rooms and a consultation room.

The light-filled clinic includes large banks of windows in the waiting areas, with patios on both sides of the building, which is located behind the Mall at Green Hills at 3810 Bedford Ave., Suite 100, near the intersection with Crestmoor Road.

Free parking is available in front of the Freeman Webb office building where the clinic is located.

In addition to VICC oncologists who are already seeing some patients at the Green Hills clinic, Vanderbilt has hired Hammad Rashid, M.D., as the first full-time hematologist/oncologist to join the Green Hills staff.

After receiving his medical degree, Rashid served his residency in internal medicine at a hospital affiliated with Cornell University in New York, and completed a fellowship in hematology/oncology at the Medical University of South Carolina in Charleston.

Hammad Rashid, M.D.

Rashid is board certified in hematology, oncology and internal medicine and was in private practice for several years in Ohio and Texas before joining the VICC faculty.

“Vanderbilt has a very strong basic science department and their clinical footprint has been expanding,” Rashid said. “I wanted to be part of that community of doctors who are at the forefront of clinical research, with national and international recognition, while still being able to see all kinds of hematological and oncological diseases.”

He is also pleased with the new clinic’s central location and easy parking access for patients.

“It is an ideal location that is very accessible for patients and it is not too far away from the Medical Center so patients who need other treatments, such as surgery or radiation therapy, can go back and forth,” explained Rashid.

For more information or to schedule an appointment, call (615) 936-8422.

Each year, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center show support for various cancer organizations by recruiting teams to participate in walks and runs.

We like to design a special T-shirt to give our participants as a way to say thank you and to show the community that Vanderbilt is united against fighting all types of cancer.

This year, we are asking for your help. If you or a friend have a theme or a design you’d like to submit for this year’s T-shirt, please email it to us at vmcpromotions@vanderbilt.edu.

We’ll be collecting submissions through Aug. 8, 2011 and will announce a winner soon after.

We hope you’ll join us for one or more of these fun events for great causes.

Please share with others on Facebook, Twitter or email. The more, the merrier!

He would grow up to become a champion cyclist and arguably the most famous cancer survivor on the planet.

Dressed in the trademark yellow of her son’s Livestrong movement, Linda Armstrong Kelly was the keynote speaker for Cancer GPS: Navigating Your Journey, Vanderbilt-Ingram Cancer Center’s annual conference and celebration for survivors and caregivers.

Kelly spoke to reporters prior to her remarks. Here are some brief video clips from those interviews:

Susan Hahn is moving again – into a new home and into a new stage of life after cancer.

The Chicago native had moved to Nashville in January 2009. She was engaged by that July and quickly began planning a big wedding. She and her fiancé had also just begun plans to tear down and rebuild his house, when “three weeks later, BAM, I was diagnosed with breast cancer,” Hahn says. “It was all so surreal – and seemed unreal.”

The ensuing events progressed quickly. Just ten days after diagnosis, she had a right-side mastectomy and 13 lymph nodes removed. A month after surgery, she and Mark were married. A couple of days after that, they moved into a rental house in anticipation of building their new home. A mere ten days after the wedding, Hahn started chemotherapy. During chemotherapy, she also prepared for reconstructive surgery with a tissue expander.

“(Chemo) was pretty tough. It was a long time, and I was sick,” she says.

The barrage of treatments – coupled with the rapid succession of other major changes in her life – took a toll on her physically and emotionally. Even though the treatments were harsh, they were straightforward. But after the treatments ended, Hahn says she realized “recovery was a harder thing to navigate than I thought it would be.

“All those changes – moving, new job, new city, breast cancer, new marriage, building a house – it was all pretty stressful,” she says. “Along with the anxiety of constantly wondering ‘am I really well?’”

A friend (and fellow cancer survivor) had suggested that she look into programs offered by the Vanderbilt Center for Integrative Health (VCIH) – a multidisciplinary healing center that combines traditional and complementary therapies with the goal of caring for the “whole” patient: body, mind and spirit.

Roy Elam, M.D., (left) medical director of the Vanderbilt Center for Integrative Health, says integrative health programs can improve quality of life and help cancer patients deal with the stress and emotional response to their illness. (Photo by Joe Howell)

Hahn brought up the idea to her oncologist, who gave her enthusiastic approval.

After her initial consultation with the center’s medical director Roy Elam, M.D., Hahn began yoga in hopes of regaining strength and improving her mobility before her reconstructive surgery.

“Not only was it painful, but when you have some new apparatus in your body, it freaks you out a little bit thinking you’re going to rip it,” Hahn says.

But the gentle yoga practice, she said, “really addressed my fears of stretching certain ways.”

The benefits, however, went beyond addressing her physical pain and mobility.

“When you start moving your body in a place where you just lost a breast or something, it’s emotionally painful as well,” she says. “And (VCIH) is the place you want to be when you’re dealing with whatever your emotional pain is.”

Hahn has since sampled nearly all of the programs offered by VCIH – qigong, nutrition classes, counseling, massage therapy and mindfulness-based stress reduction.

“I was so fragile in the beginning, but I didn’t want to stop moving. I wanted to climb back into my body, and this is the way to do it.”

Breaking the fall

This time of transition – after the chaotic torrent of surgeries, chemotherapy and other cancer treatments ends and the “life after cancer” phase begins – is difficult for many cancer survivors.

“That moment when the treatment stops it can feel like falling off a cliff,” describes Rachel Mitchell, yoga instructor at VCIH. In addition to the physical limitations and fatigue that result from cancer treatment, the experience can also affect patients’ relationships with family members and at work.

Psychotherapist and qigong instructor Michelle Foote Pearce, L.P.C., R.N., M.S.N., D.Min., sees many clients at that pivotal time.

“That’s when some of the emotional fallout can hit,” she says. And there’s actually a lot more healing and recovery that needs to happen at that point.”

Psychotherapist and qigong instructor Michelle Foote Pearce, L.P.C., R.N., M.S.N, D.Min, (right) notes that after treatment ends, “there’s actually a lot more healing and recovery that needs to happen at that point.” (Photo by Joe Howell)

Pearce says people come to the center trying to figure out how to make sense of their experiences and move forward.

“Often they are very motivated to move forward into a more healthy lifestyle, to take care of themselves and their family in a different way,” she notes. “So that’s a nice time for us to be seeing them and …to offer them things to help them move forward in their recovery, whatever that might mean for them.”

The programs, says Elam, “focus on caring for the whole person…and on empowering people to take care of their own health.”

VCIH offers only therapies with demonstrated health benefits – e.g., massage therapy, acupuncture, health coaching, nutrition counseling, psychological consultations, and classes in mindfulness/stress reduction, yoga, tai chi and qigong.

In clinical practice guidelines published in 2009, the Society for Integrative Oncology, which reviews and evaluates research on various complementary therapies, noted that “mind-body” practices (which includes yoga, meditation, tai chi, hypnosis and relaxation techniques) can reduce anxiety, depression and mood disturbance, improve coping skills, reduce chronic pain and nausea, and improve overall quality of life for cancer survivors.

Elam points out that the programs are meant to “complement,” not replace, a patient’s traditional medical treatments by offering therapies to improve their quality of life. The center does not practice “alternative” medicine – so there are no crystals, no herbal concoctions, no magic spells.

The role of integrative medicine in cancer care is not to prolong the patient’s life, “although it is a wonderful thing if that occurs,” says Elam, who is also an internal medicine physician.

“Our role for cancer patients is to enhance the quality of their life, and especially to deal with the stress and emotional response to their illness.”

Minding your health

Some of the questions that may race through a patient’s mind after a cancer diagnosis – questions like: “Did I do something to cause this?” “Why didn’t I see this coming?” “What will happen next?” “How long do I have?” – can keep the attention on the past and future and cause tremendous fear and anxiety.

A central strategy in integrative health is to calmly refocus one’s attention on the present – a concept known as “mindfulness.”
Pearce describes mindfulness as “a compassionate way of accepting where we are before we can move someplace else.”

Breast cancer survivor and qigong instructor Kathy Woods says that qigong has helped her feel “more at home and appreciative of this embodied life than I was before I had cancer.” (Photo by Joe Howell)

“Mindfulness is central to the approach that we take with all the types of therapies we do here…because it is so evidence-based – evidence that it is effective in reducing stress, enhancing the immune system, enhancing psychological well-being,” says Pearce.

Mindfulness is a key component of qigong (pronounced “chee-gung”), a Chinese martial art that emphasizes synchronized breathing and physical movement with awareness and “moving meditation.”

Breast cancer survivor Kathy Woods teaches qigong at the Vanderbilt Dayani Center, a medical fitness facility offering a variety of fitness and wellness programs – including mind-body practices like qigong, tai chi and yoga.

Woods discovered qigong when her husband, VCIH mindfulness instructor Gordon Peerman, D. Min., was developing a mindfulness-based stress reduction (MBSR) class.

Yoga had traditionally been the movement practice paired with the sitting meditation in such programs.

“We enjoyed teaching yoga, but we found that a lot of people who came to take our class found the yoga more challenging than we wanted the experience to be for them. But we found that qigong was such an accessible movement practice – everybody could do qigong,” says Woods.

When diagnosed with breast cancer in 2001, Woods decided to retire from her post as head of the “lower” (elementary) school at the University School Nashville and focus on getting herself well, which included learning more about mindfulness and qigong. Eventually she began teaching MBSR classes with her husband and offering qigong as a component of the class. Then, in 2006, Woods began teaching a qigong class for breast cancer survivors at Dayani, which has now expanded beyond breast cancer patients and is open to anyone.

“I’ve had students in my class at Dayani who do parts of the practice sitting in a chair, and I think they still get the benefits.”

The gentle, choreographed movements of qigong are similar to those of tai chi. But qigong is often easier to learn, Woods says, and therefore, more accessible and appropriate for someone recovering from an illness like cancer.

From personal experience and her observations as a qigong instructor, Woods notes that qigong and related therapeutic movement practices can be a particular help to cancer survivors.

Research at Vanderbilt-Ingram is hoping to identify ways to help survivors like Adrien MacKenzie "thrive." Click photo to read more about the program.

“If you’ve had surgery or radiation, these procedures change your body. What are you going to be able to do, and how are you going to feel? This new body is not what you’re familiar with.”

The slow, flowing movements of qigong can help strengthen the legs and upper back and help with maintaining and enlarging range of motion, she says.

Qigong can also provide tools to deal with stress that can be applied outside of class. Each exhale, Woods says, is an opportunity to experience relaxation.

“Qigong is a way of toning the nervous system. With every activation of the sympathetic nervous system on the in-breath, there’s a balancing activation of the parasympathetic system on the out-breath. You get more sensitized to how it feels to be energized and how it feels to be relaxed.”

During class, Woods asks students to notice how the energizing effects of holding the arms up overhead dissipate as the arms are lowered, and to experience the peace and stillness of that moment.

“The idea of settling yourself in the stillness as if it were the rest in a line of music…if you can really practice that oscillation (between activation and relaxation), it becomes much more accessible.”

Hahn says the stress-relieving strategies she learned in qigong class at VCIH got her through an anxiety attack during a recent root canal.

“I closed my eyes and I visualized Michelle (Pearce), and I did some of her qigong and breathing to bring my heart rate down. It really helped,” Hahn says. “Though the endodontist might have thought I was a little crazy!”

But beyond the physical benefits, such practices can help a cancer survivor begin to feel “at home” in this new body that may have been altered by cancer treatments.

“I found that mindfulness – but in particular qigong – has made me feel more at home and appreciative of this embodied life than I was before I had cancer,” says Woods.

“I think there’s a kind of grace inherent in the practice that reminds you that this life is something to be grateful for every day.”

Moving day

Less than two years past her cancer diagnosis, Hahn is getting back to something resembling life “before cancer.” She’s been able to step up her physical activity, returning to higher intensity yoga classes, working out with a personal trainer at the YMCA, and hiking a 5.8-mile trail at Percy Warner Park once a week.

She still makes time every month for massage therapy and counseling and has been able to integrate what she learned from the other programs into her daily life.

Susan Hahn credits integrative health programs like yoga and qigong for helping her “climb back” in her body after a breast cancer diagnosis. (Photo by John Russell)

“I’m actually doing well, I feel energized enough to work full time and keep my life up and running while I try to work out every day and transition to a new house.”

Most of all, she’s beginning to reclaim her identity, no longer wanting or needing to identify as “the cancer girl.”

“I didn’t want my life to be all about cancer. I wanted it to be about health and recovery,” she says. “(VCIH) is not all about cancer, and that’s what I like about it. That’s why I’m still going. You don’t want to be constantly reminded that you’re the cancer girl; I’m just another person looking for better health.”

As she and her husband now prepare to move into their new home, Hahn recalls proclaiming to her architect as they were designing the house: “When this house is built, I will be well.”

“And sure enough, here I am.”

Even though the house isn’t finished yet, Hahn sees the beauty in it just as it is today – acceptance that she carries into her perspective of life after cancer.

“It’s a beautiful house. It’s in various stages,” she says. “But we’re all in various stages.”