Texas Health Presbyterian Hospital Dallas
Vol. 3, No. 1 — May 2013
In this Issue
Nurse Overcomes Bone Cancer
Angie Gray is used to taking care of patients, not being one. So when the registered nurse from Wichita Falls needed the services of Texas Oncology at Texas Health Presbyterian Hospital Dallas, she recognized the superior care they provide their patients.
In August, 2012, Angie, 40, scheduled an appointment with an orthopedic doctor in her hometown after she couldn’t bend or move her right leg.
“I thought it was going to be an MCL or some other orthopedic issue,” Angie said.
But after her doctor referred her to Bijal Modi, M.D., an oncologist on the medical staff at Texas Health Dallas, she was informed she had osteosarcoma in her right femur.
“He made me feel good about my prognosis,” Angie said.
Angie, who is mother of two boys ages 17 and 12, required four rounds of chemo to reduce the size of the tumor in her leg. She was extremely grateful that her doctors allowed her to be admitted on weekends for chemotherapy so she wouldn’t have to make the two-hour drive from Wichita Falls multiple times a week.
After completing chemo, Angie had surgery with Jorge Casas, M.D., a surgeon who specializes in orthopedic oncology with Texas Health Dallas, just before Thanksgiving to remove the tumor.
The surgery was successful in removing the majority of the tumor, but her white blood count dropped soon after and she had to stay inside. The family had to cancel a big vacation they had planned to Mexico for Angie’s 40th birthday.
“My friends and family pretty much just dropped gifts off on the door step and yelled happy birthday,” Angie said, laughing.
After the New Year, she began another four rounds of chemo, which ended on March 10.
Although she has to follow-up every two months and is going through physical therapy, Angie is happy to say she is now cancer free.
The RN said she won’t forget the tremendous care she received and knows she couldn’t have made it this far without the help of everyone at Texas Health Dallas.
“The first day I was there, I was a basket case and everyone was so supportive,” Angie said. “I have nothing but good things to say about how I was treated.”
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A diagnosis of cancer can be overwhelming, confusing and create anxiety and uncertainty. As a patient at Texas Health Presbyterian Hospital Dallas, patients never have to face this diagnosis alone. Our oncology nurse navigators are available to help both inpatients and outpatients navigate the system from diagnosis through survivorship.
The goal of the nurse navigator program is to:
- Identify barriers to treatment
- Provide education and direction to hospital and community resources to help eliminate those barriers
- Help patients understand their diagnosis and treatment plan
- Advocate for patients by voicing concerns to the healthcare team
- Help facilitate decision-making
- Coordinate care between medical specialties when needed
- Provide a constant support for the patient in order to prevent gaps in care
Providing these services will help patients feel supported throughout their cancer journey and has been documented to improve outcomes overall. Navigators are provided as a complimentary service and are based on physician referral.
Oncology nurse navigators have a unique skill set in dealing with cancer; they are certified in oncology nursing and have many years of experience dealing with active treatment, symptom management, and end of life care. They can provide education and resources that are tailored to the cancer patient and be a constant support for the patient during this difficult time.
For more information about our oncology nurse favigation program, please contact our office at 214-345-6625.
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HPV and Cancer
By Bijal Modi, M.D.
Squamous cell carcinomas of the head and neck (SCCHN) are diagnosed in more than 550,000 people worldwide, with approximately 53,000 affected in the United States. In 1983, it was first postulated that Human papillomavirus (HPV) may be related to SCCHN when human papillomavirus structural proteins were detected in SCCHN specimens.
It is estimated that 25,000 cancers are caused by HPV in the United States annually. Cervical cancer represents the vast majority of these tumors. However, oropharyngeal, anal, penile, vaginal and vulvar cancer have also been linked to HPV. An evaluation of oropharyngeal cancer specimens for HPV from 1984 to 2004 demonstrated increasing evidence of HPV from 16 to 72 percent over the time period. If current trends continue, new cases of HPV induced SCCHN will outnumber cervical cancer by 2020.
HPV induced malignancy is a distinct entity from classic tobacco/alcohol induced SCCHN. Epidemiologically, HPV induced tumors tend to present in much younger patients, on average 10 years, as compared to traditional SCCHN. A number of patients present in their 30s or 40s, ages previously unseen in this disease. HPV associated disease tends to have a smaller and less invasive primary tumor but more involvement of cervical nodes.
Distant metastatic disease is much less common in HPV associated tumors. If and when distant metastatic disease does present, it occurs later. Second primary tumors, a major concern with traditional SCCHN due to field effect, are significantly less common. Finally, HPV induced SCCHN offer significantly better survival rates compared to traditional SCCHN.
Transmission of HPV is generally considered the most common sexually transmitted infection. Meta-analysis data estimates a 10 percent active anogenital infection rate in women worldwide at any point in time. Prevalence rates in men are not as well studied; however meta-analysis data released in 2006 reports seropositivity rates in line with female infection rates.
Finally, a study focusing on oropharyngeal infection rates in both men and women in the US demonstrated a 6.9 percent overall HPV infection rate with a 1 percent HPV-16 infection rate, the subtype most commonly linked to SCCHN. Oral HPV infection rates were found to be approximately three times more prevalent in men compared to women, comparable to rates of HPV induced SCCHN between men and women.
Due to the high infection rates in the general population and the association with a number of malignancies, as high as 25,000 annually in the U.S., vaccine therapy has gained greater importance. Two vaccines are currently available in the US, Gardasil and Cervarix. Data demonstrates that these vaccines were effective at preventing cervical intraepithelial lesions. The timing of vaccination played a major role as the vaccines seemed most effective if given prior to the initiation of sexual activity. Currently the American Cancer Society recommends vaccination of females offered from ages 11 to 18.
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Oncology Nurse Named to DFW’s 'Great 100'
Victoria Jiles, B.S.N., R.N., O.C.N., an oncology nurse at Texas Health Presbyterian Hospital Dallas, was one of six nurses from the hospital to be named to Dallas-Fort Worth’s "Great 100 Nurses" for 2013.
B.S.N., R.N., O.C.N.
Victoria sought early exposure to health care by attending a high school for aspiring health care professionals where she clarified her choice to become a nurse. As a teenager she worked at a small hospital as a patient aide, giving baths and making beds. After completing a bachelor's degree, she chose a medical-surgical unit for her first 10 years of practice before specializing in oncology 15 years ago. She is a respected clinician serving as a resource to other units for patients with limited IV access, member of the Oncology Nursing Society, certified in oncology since 2007 and has served as a preceptor for new nurses.
Victoria has served in many leadership roles, including charge nurse, evening supervisor, and infusion room manager at a cancer research clinic. Currently, in a fast-paced outpatient oncology infusion clinic, she is a gifted communicator and collaborator, establishing effective relationships with physician office staff across the Metroplex to achieve positive outcomes. She has received numerous compliments and awards for the patient centered service she provides. Resilient in the face of a busy day, her calming presence puts team members and patients at ease. Her innovative solutions such as adapting the environment and flexing her schedule have accommodated increased patient volume.
Victoria’s wit and charm make every interaction with patients positive. She is described as “kind” and “funny.” One of the clinic’s regular patients said “I just fell in love with her! Her sense of humor is fantastic. She’s always smiling and wanting to do something for someone.” This patient described a visit during the holidays when her infusion kept her in the clinic after all other patients had gone home. This nurse inquired if there was anything else she could do for her and a personal issue was heavy on the patient’s mind. This nurse sat and listened while the patient shared this problem. “It meant so much to me that she took the time to listen and never appeared impatient or rushed.”
Victoria extends her expertise beyond oncology services, championing the implementation of a higher standard of care for oncology patients hospital wide by administering chemotherapy to patients on other units like the ICU, ER, and Rehab. This program assures that the ONS standards of care are provided to all patients receiving chemotherapy regardless of unit assignment. Her in-depth knowledge regarding chemotherapy medications and community resources is communicated to patients at their level of understanding, empowering them to make decisions about their care. Highly respected by her peers she was the Oncology Unit Nursing Excellence nominee.
Above and beyond her work commitments, she volunteers at church where she serves as an usher, feeds the homeless in south Dallas and the elderly in a south Dallas nursing home monthly. She relates that they play BINGO, sing, and pray with them and that prayer is an important part of the visit since most do not get to attend church regularly. She shares her clinical expertise volunteering weekly at a free clinic providing affordable chemotherapy to uninsured patients.
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