Urgency Matters, and the Assessment Treatment Center Responds

It was getting late that night, about two months into Jon’s cancer treatment. At first he just didn’t feel well in a way he couldn’t explain, but then he started feeling hot on a cool fall night. He broke out into cold sweats. What might have been a harmless, passing rise in body temperature that other people could ride out was a potentially dangerous symptom for a lymphoma patient. 

The memory of this evening now brings Jon feelings of gratitude — for the swift action and familiar expertise of the staff of Roswell Park’s Assessment and Treatment Center (ATC), who shifted the course of the night for the better.

Jon and his wife, Kim, made a quick call to Roswell Park once they realized what was happening to him, knowing it could be caused by the cancer or his treatment. The nurse on the phone told them to come now.

“Security helped us inside and up to the clinic. A nurse and doctor were waiting for us, and we got right in. I was evaluated and in a room right away,” Jon says. Before long, he and Kim were able to breathe a sigh of relief as the doctor treated his fever and sent him home. What also brought relief was how efficiently the ATC worked.

Had it not been for the ATC, Jon’s night could have turned out much differently. Fever, shortness of breath, weakness — when you’re a cancer patient, these and other symptoms can indicate very different problems than they do for other patients. Medication, chemotherapy, other treatments or even the cancer itself could be responsible. Having the expertly trained and knowledgeable staff of the ATC at the ready for these late-night urgent medical needs can truly be the difference between life and death. 

Why This Kind of Urgent Care Matters for Outpatients

Roswell Park supporter Robert Nuchereno saw firsthand what his brother Ray experienced when he had to turn to another hospital for emergency care before the ATC was available at Roswell Park. Their care team was not familiar with his history of multiple myeloma, and it became a grueling situation for Ray and his loved ones. Not wanting another family to go through a similar situation, Robert worked with Roswell Park to create the Assessment and Treatment Center so they would be able to treat cancer outpatients experiencing urgent but nonlife-threatening situations. 

The Assessment and Treatment Center opened in 2017. Thanks in part to donations, and with the fundraising leadership of Robert Nuchereno and his family, Roswell Park was able to make the ATC available 24 hours a day in 2018. It’s now accessible to our outpatients any time they need its care, day or night. 

Finding Comfort in Consistent Care

Because Jon was seen at Roswell Park, the ATC’s medical staff had all his records on hand. “We were treated right away,” he says, “and we felt comfortable. We did not have to go through a registration process. We knew we were in the right place. My care would be consistent. 

“When you are going through chemo, having the ability to come to a place that knows you when you have an issue associated with your treatment is critical. In an emergency room, you are not a known person; you have to be evaluated and explain everything, which can be difficult, and then have to wait for your records and so forth.” 

Jon has been a key Ride For Roswell volunteer since 2006, so he knows full well the importance of donations. Seeing them at work in the Assessment and Treatment Center really struck home for him. 

“It is very comforting knowing that the ATC is available. I think it is vital. It’s a peace of mind for a cancer patient that if they do have something, there’s a place they can go, and you’re not going to be a number in a line.” 

Jon is doing well today. But he’s glad the ATC is there, and glad for all other Roswell Park patients who find themselves needing it, too.

As a volunteer, it was very gratifying to see firsthand that the funds you help raise are making an impact for cancer patients. You realize that raising funds does make a difference.

Rachel’s Story: How Donor Giving Made Her Bone Marrow Transplant Possible

Only when her doctors told her she was going to die without one did Rachel understand how critical a bone marrow transplant was.

Just two months before hearing these words, the RN had rarely been sick a day in her life. A South Dakota native now living in Lewiston, New York, she loved reading and traveling but especially being with her family: her husband, three teenaged children and three cats. Then, in December 2017, she developed an odd fever that hit every night for eight straight days.

Although she looked fine, her white blood cell count proved otherwise, reading at 120,000, or 10 times higher than a normal count. The always-healthy nurse was diagnosed with acute myeloid leukemia.
That was a Friday. On Monday, the oncologist told her to go straight to Roswell Park, without even stopping at home. She was admitted right away.

Dr. Elizabeth Griffiths, a leukemia expert in the Department of Medicine, started talking to Rachel about a bone marrow transplant (BMT), but Rachel was worried about graft-versus-host disease (GVHD), where donated cells attack the donor’s body. So they started her on chemotherapy. After several weeks of treatment, she was able to go home. But then her white blood cell count spiked to 199,000.

Dr. Griffiths admitted her again and told her, in no uncertain terms, that there was no more time for wait-and-see. Now, two months after her diagnosis, Rachel had to have a bone marrow transplant, or she was going to die.

finding a match

Most white blood cells are produced in the bone marrow. Leukemia is cancer of bone marrow and/or other tissues that produce blood. So when the bone marrow malfunctions like it did in Rachel, sometimes the only hope for survival is to replace it with a transplant from a donor.

Finding a donor means finding someone whose HLA, or human leukocyte antigens, match the patient’s. HLA are proteins found on most cells in your body. Matching HLA is critical to the growth and development of healthy new blood cells and in reducing the risk of GVHD, Rachel’s initial fear. The more similar the HLA, the better the chance of a successful transplant.

Doctors first look for a match among the patient’s siblings. When that fails, they turn to the public. Fortunately, organizations like Be the Match help patients connect with volunteer donors around the world. But it’s not cheap, and insurance often doesn’t cover the cost of testing those potential matches.

This is where generous donations to the Roswell Park Alliance Foundation have come in. “They help us cover the cost of tissue typing, which helps identify a potential donor for a patient who needs a blood or marrow transplant to cure their disease,” says Dr. Philip McCarthy, Director of Roswell Park’s Transplant and Cellular Therapy (TCT) Center and the doctor who oversaw Rachel’s BMT. In 2018 alone, donations funded 68 searches resulting in 68 matches for our patients.

Donor support also helps the TCT team find matches faster, which can make all the difference in these situations, says Dr. McCarthy. “With this kind of donor support, we can offer a faster time to providing curative therapy and potentially save more lives. If we can’t get to them in time, their disease could get beyond our ability to treat or control. We may miss our only window of opportunity.”

rachel's donor

Rachel’s donor was found in Europe. In March of 2018, the TCT team performed Rachel’s bone marrow transplant. After the procedure, the doctors and staff monitored her for several weeks to make sure her numbers got back to a good level and her
body was healing.

A year and a half later, Rachel is doing great. She’s working again at the hospital where she’s been for almost 16 years. And she’s grateful for the role donations to the Roswell Park Alliance Foundation played in her story.

“That donors have helped provide this testing is just amazing. I can’t stress enough the importance of not having to worry about trying to finance a donor search. When you get a cancer diagnosis, it is so much to process. I know I was shocked — in complete disbelief at first. You’re confused, tired, scared, ill from treatment, and you just want to put on a brave face for loved ones. There is just no way someone could be organizing a way to get the funds for a donor search.

“And in my case, time was of the essence. I am forever grateful to my team at Roswell Park. They were there for me and advocated for me when I wasn’t sure what to do.” 

Donations Put Cutting-Edge 3D Models in Surgeon’s Hands

“Look what we’ve started. This is so exciting.”

Dr. Larson Hsu, board-certified radiologist and Staff Physician in the Department of Diagnostic Radiology, is showing Dr. Ermelinda Bonaccio, Chair of Diagnostic Radiology, how to use the 3D virtual reality (VR) headset he’s programmed. Special controllers in her hands allow her to grab a 3D model she’s seeing and pull it toward herself, then turn it around and upside down. Dr. Hsu made this 3D model from a CT scan of a patient’s cancer. It’s an exact model of his left lung with a lower lobe metastasis, which the surgeon will remove tomorrow.

Generous donor giving to the Roswell Park Alliance Foundation has allowed the Department of Diagnostic Radiology to equip Dr. Hsu’s lab with this transformative program. VR can make a huge difference for surgeons by showing them the real-life intricacies of cancerous tumors and patient anatomy, and how each has affected the other. In this case, they can see how this lung tumor has eaten into the patient’s airways, what kinds of blood vessels are involved and what might be at risk once excision begins.

Dr. Hsu is passionate about finding ways to use 3D technology to make surgery more predictable. As VR becomes more commercially available in the video game industry, he started thinking about utilizing it in medicine as well. “I had been playing with virtual reality quite a bit. I had made art in virtual reality, too, and I thought, What if I can take these 3D models from the computer screen, bring them into virtual reality and see them right in front of me? That’s what we are doing here.”

He compares the process to painting, taking a 2D CT scan and transforming it into an interactive 3D model using FDA-approved software, tablet and pen. Surgeons can then use the VR headset before surgery to explore what awaits them inside a patient’s body and use portable headsets in the OR itself as a guide as they move through surgery.

Dr. Hsu is working on another fascinating way to use 3D models, too: a 3D printer also made possible by donations to the Alliance Foundation.

Dr. Hsu sees it as another critical component in the future of cancer surgery. 

With a 3D-printed, patient-specific anatomical model, doctors can not only see but feel exactly how a tumor surrounds and intertwines with an organ. They can feel the same things their fingers will actually touch when they operate on the patient. There’s more involved in getting a printer set up right now, and it comes with higher costs, but in a few years, he believes insurance will cover them. 

Both methods are pretty amazing. “Once we have a 3D model, the potential is endless,” Dr. Hsu says.

There’s another benefit, too: Seeing 3D models of their cancer can help patients understand what’s going on with their disease and the potential impact of surgery. It can mean peace of mind when making a life-changing decision. 

All this will make Roswell Park a pioneer in the use of 3D technology, Dr. Hsu says. He believes he’s holding the future in his hands. 

“Look what we’re doing thanks to donor dollars!” he says. “I’m excited about the evolution of this rapidly developing technology.”

To see examples of 3D VR models created by Dr. Hsu, visit www.bit.ly/Roswell3D.