feature story

Caring for Cancer Patients

By Becky Wiese

Dr. John Migas, Dr. Bhanu Vakkalanka, Dr. Hwan Jeong, Dr. Pramern Sriratana

ancer doesnt always produce the same dire outcome as it did years ago. Thats not to say that hearing the word cancer from your primary care physician isnt frightening. But the advances in cancer treatment, including chemotherapy, targeted drugs, and radiation, along with the ever-increasing knowledge of how certain cancers behave, have helped more and more patients survive and go on to live full, productive lives. The physicians, nurses, and staff at Mid-Illinois
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Hematology and Oncology Associates (MIHOA) work diligently to utilize the latest treatment information along with in-depth care to make sure each patients experience is the best it can be every step of the way. The Newly Diagnosed Patient Patients are referred to us by their primary doctor after a pathologist has made the diagnosis of cancer, explains Dr. Pramern Sriratana,

an oncologist who has been with MIHOA since its beginning in 1979. We have a multidisciplinary approach to treatment, which includes twice-weekly meetings with the oncologists, radiation oncologists, surgeons, nurse practitioners, and any other interested party, including the primary care physician, to review a patients case. They review the diagnosis and results of tests and discuss the type of cancer, where it originated, and how advanced it is. Pathology reports, mammograms, X-rays, and other diagnostic tests are considered as well. All of these factors influence the treatment plan and help determine what steps will be taken, such as chemotherapy, radiation, hormone therapy, or additional surgery. We do all we can to benefit the patient, says Dr. Sriratana. Patients want to know what can be done, so its important to include them in the decision-making process. Even when expertise from a third party is necessary, such as from a larger cancer center like Mayo Clinic, BarnesJewish Hospital, or Sloan-Kettering in New York, the desire of the patient and the patients family weighs heavily in the decision. In addition to treatment options, educating the patient about what those options may involve is also important. For example, information about chemotherapy, its side effects, and things to watch for are all discussed so that the patient knows more going in and has a better perspective about what may or may not happen. Physical condition, age, and other personal factors are taken into consideration so that the treatment becomes very individualized, based not only on the diagnosis and standard treatment protocol set forth by the National Comprehensive Cancer Network (NCCN) guidelines, but also on what the patient as an individual desires as well as what he or she can and cant tolerate. Patient education is very important, states Dr. Sriratana. It helps them understand the nature of their disease, as well as the factors that come into play throughout their treatment. The on-site library at the Community Cancer Center offers excellent information for patients to peruse; support groups and networks are other valuable sources of information and often prove to be critical for patient care. Reviewing information the patient has heard is important in making the patient feel comfortable. Sabrina Petersen, a Certified Oncology Nurse, explains that after the patient has seen the doctor and comes to the infusion area, one of the nurses meets with the patient in order to help them get acquainted with the surroundings. Even before the first IV stick, we introduce them to the area and different parts of the facility to help them feel more comfortable. In addition, the nurse will review the schedule of treatment and give an overview of the drugs that will be used. We make sure the patient understands that what was discussed with the doctor is what will happen in the infusion area. Well talk about lab work, the amount of time they should expect to spend the various things they can anticipate during each visit, says Petersen. The nurses go through information in-depth so the patient can feel confident at home, but nurses are also available 24/7 for questions and concerns as they arise. Patients also receive a packet of information regarding their treatment and what to expect that serves to reinforce what theyve been told that way they dont have to try to remember everything. MIHOA and The Community Cancer Center Another benefit for patients at MIHOA is that so many of the services or resources they need are all under the same roof at The Community Cancer Center. The four physicians, including Dr. Sriratana, Dr. Hwan Gon Jeong, Dr. John Migas, and Dr. Bhanu Vakkalanka, a nurse practitioner, and eight registered nurses, plus three lab technicians, make it easy for a patient to see their doctor, have their blood work done, get a CT scan, and receive chemo or radiation treatment all at the same location. Other supportive care that is available includes a social worker, a dietary counselor, a chaplain, and information about support groups

Lyndi Alberts, APN, FNP-BC with Allison Ruff, cancer survivor, sharing a moment of good news.
in the community. These caregivers are important parts of the support team. For example, says Dr. Sriratana, the dietary counselor can discuss the adverse side effects such as diarrhea, vomiting, and mouth sores that can happen due to chemo treatments and help the patient choose foods that may be easier for their body to handle during this time. The social worker not only offers psychological and social support, but is often very helpful regarding financial information and finding drug programs that provide medication at a lower cost to the patient. The chaplain provides support and encouragement to patients of all faiths. Three other essential support personnel include a patient advocate called a navigator, a genetic counselor, and a clinical research coordinator. The Community Cancer Center offers a breast navigator who is trained to counsel patients at the time of diagnosis regarding their options with surgery, chemotherapy, and radiation treatments. Navigators are an essential part of the support team, says Dr. Sriratana. The navigator is there for the patient at every step throughout their treatment; the patient can call the navigator at any time. The genetic counselor is a specially trained nurse who works to help determine the risk of a certain type of cancer developing due to genetics. Several cancers are known to run in families and tests can be run to determine the risk, Dr. Sriratana explains. Breast cancer and colon cancer are two such cancers that have screening tests that help determine potential risk. The genetic counselor studies the family history and works with insurance companies to obtain approval for screening tests, which will reveal the genetic predisposition for developing cancer. This knowledge helps the physician and patient determine a course of action as early as possible. A clinical research coordinator helps patients who qualify and are interested get into clinical research trials. Jennifer Peterson, the Clinical Research Coordinator for MIHOA, is quick to say that participating in a clinical trial is not for everyone. Its not a miracle drug, she says, and it is not necessarily better than the current standard treatment. Clinical trials are usually comparative studies that are available for most common cancers. The opportunity to become a part of a trial is reviewed by the physician at the beginning of treatment; an interested patient must go through a consent and screening process. Acceptance depends on the stage and type of cancer, performance status, and other eligibity criteria.
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MIHOA Practice Profile

Staff: Four physicians One Nurse Practitioner Eight nurses Laboratory staff Research coordinator Office coordinator, and records, billing, and front desk staff Pramern Sriratana, MD , Founded MIHOA in 1979  B oard-certified in Internal Medicine, Hematology, and Medical Oncology  Medical degree from Ramthibodi Hospital Mahidol University, Bangkok, Thailand  I nternship and residency in Internal Medicine and fellowship in Hematology/Oncology at St. Francis Hospital, Evanston, IL Hwan Gon Jeong, MD, Joined MIHOA in 1990  B oard-certified in Internal Medicine, Hematology, and Medical Oncology  M edical degree from Kyungpook National University, School of Medicine, Taegu, Korea  Internship at Maryknoll General Hospital, Pusan, Korea; residency in Internal Medicine at St. Elizabeth Hospital Medical Center, Youngstown, OH; fellowship in Hematology/Oncology at Cleveland Clinic Foundation Hospital, Cleveland, OH, and University of California, Los Angeles John J. Migas, MD, Joined MIHOA in 1997 Board-certified in Internal Medicine and Medical Oncology  M edical degree from Rush Presbyterian St. Lukes Medical Center, Chicago.  I nternship and residency at University of Minnesota Hospitals & Clinics, Minneapolis, MN; fellowship at University of Iowa Hospitals & Clinics, Iowa City, IA Bhanu Vakkalanka, MD, Joined MIHOA in 2012 Board-certified in Internal Medicine and Medical Oncology  Medical degree from Rangaraya Medical College, Kakinada, India University- Andhra University  Residency at Metro Health Medical Center Case Western Reserve University Cleveland, Ohio and fellowship at Taussig Cancer Center Cleveland Clinic Foundation Cleveland, Ohio Lyndi Alberts, APN, FNP-BC, Joined MIHOA in 2013 as a Nurse Practitioner Board-certified as Family Nurse Practitioner  M aster of Science in Nursing from Illinois State University  B achelor of Science in Nursing from Illinois State University

Katey Lally, RN, BSN, Patty Detweiller, RN, OCN, Laurie Robinson, RN, OCN, Sabrina Petersen, RN, BSN, OCN, Andy Reichert, RN, Lisa Lowry, RN, BSN, Ginger Brooks, RN, Jeanne Aden, RN, OCN
The treatment is very regimented regarding timing and doses of specific drugs or drug combinations as well as tests, explains Peterson. Patients also have to monitor side effects. Many clinical trials are looking at the effectiveness of a drug and its potential side effects. They serve an important role, as they have enabled drugs to become more effective, such as target drugs that attack specific types of cells and amounts of drugs that can be used effectively without being as toxic to the patient. Having all these resources, plus an amazing network of volunteers, in the same facility is a huge benefit to patients. And the benefits will be expanding as the Community Cancer Center recently broke ground for a new addition which will double the space for patient treatment, have more room for physician conferences, increase the patient education area, add a chapel, and even allow patients to walk outside in a beautiful, peaceful garden setting. Mid-Illinois Hematology and Oncology Associates recently became a QOPI (Quality Oncology Practice Initiative) certified practice. This designation is given by the American Society of Clinical Oncologists and is based on quality of care and chemotherapy administration standards. Less than 10 percent of all oncology practices qualify for QOPI certification, making MIHOA an excellent option for personalized, compassionate care combined with advanced technology and treatment options for patients. Cancer patients in Central Illinois have several compelling reasons to stay close to home as Mid-Illinois Hematology and Oncology Associates offers the highest quality cancer treatment, compassionate support, and on-going follow-up care. With the advances in technology that diagnose and treat cancer earlier, better, and with more success than ever before, the goal and increasingly end result is to take you from cancer patient to cancer survivor.

For more information, you may contact Mid-Illinois Hematology & Oncology Associates, Ltd. at 309-452-9701. They are located inside the Community Cancer Center at 407 E. Vernon Avenue in Normal.
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