New surgical robot available at UPMCBy Umamasheswar Duwuri, MD, PhDDirector of Robotic Surgery,Department of Otolaryngology, University of Pittsburgh

Minimally invasive approaches have become more common in many medical fields. Oneform of minimally invasive surgery is robotic assisted surgery (also called robotic surgery).Robotic surgery incorporates the use of robots in performing surgery. e first surgicalrobot was introduced in 1985. Since then, robotic technology has been developed rapidly.Conceptually, the robot allows the surgeon to access small anatomic areas, provide better visualization and to minimize physiologic tremors.

e most common surgical robotic system was initially developed for cardiac andabdominal surgery. However, surgeons from other fields like Otolaryngology: Head andNeck Surgery have used this system, albeit with some difficulty. Now, there is a new surgical robot that has been developed especially for Head and Neck surgery. is device ismade by the MedRobotics Corporation and incorporates flexible robotic instruments. istechnology has the advantage of ‘looking around the corner’, especially in hard to reachareas like the base of the tongue or the larynx. is new device was developed throughcollaboration between the University of Pittsburgh and Carnegie Mellon University. iscollaboration led to the creation of the MedRobotics Corporation, which is now based inBoston, Mass.

ese anatomic regions are very difficult to reach using conventional methods and suchsurgeries are associated with prolonged hospital stays and generally necessitate theperformance of a tracheotomy. With the use of robot-assisted surgery, we can now accessthese areas through the mouth, with excellent visualization and surgical exposure.

Many cancerous and non-cancerous conditions can be treated with these methods. Recently,we have employed robotic technology to remove excessive tissue from the base-of-tonguefor patients with severe obstructive sleep apnea (OSA). Preliminary results demonstratethat this is a safe and feasible procedure with minimal patient discomfort (all patients haveleft the hospital within 1-2 days, tolerating an oral diet). Some patients have experiencedrelief of symptoms and improvement of their sleep disturbance scores.

Most recently, a surgeon from UPMC traveled to Europe, specifically Phillips University in Marburg Germany to perform robotic operations using this new device. We successfullycompleted these operations, with the assistance of German surgeons. e program has now expanded to UPMC, especially after the recent FDA approval that was awarded to this device.

In summary, robotic-assisted surgery of the head and neck is an exciting novel method thatallows us to offer patients an alternative to traditional open surgery. Our initial experiencesuggests that this method reduces patient discomfort and promotes early post-proceduredischarge from the hospital.

Page 1New surgical robot available at UPMC

Page 2Lucky or unlucky?

Page 3A new era of personalized medicine

If I could only talk!

Page 4Seven key fitness programcomponents

Page 5The healing journey

Page 6Swallowing Disorders Center

Clinical trials

Contact information

Head and Neck Cancer Program website

H EADWAYNEWS ON ADVANCES IN THE PREVENTION, DETECTION, AND TREATMENT OF HEAD AND NECK CANCERS

Winter 2016

continue to travel to Johns HopkinsHospital in Baltimore for the whack-a-mole approach to killing cancer that somany ACC patients pursue around theworld. Both Allegheny Health Networkand UPMC are participating in cuttingedge research on genetic testing,immunotherapy and targeted treatmentsthat hold exciting promise for all cancers,but especially for the rare orphan cancerslike ACC.

When telling my story, I often laughwhen I get to the third cancer. Mylongevity is a bit absurd. After all this, itseems that I really shouldn’t still be here.It would take no effort to spend my dayson the dark side feeling sorry for myself.But in 2013 I found the ACCOrganization International, www.accoi.org,a global online patient website anddiscussion forum connecting ACCpatients through support and the sharingof resources. is all-volunteer groupgives people hope, information and afamily who understands. (Re-enter LadyLuck, stage right.)

So when people ask me how I cope, myanswer now includes a deeper under -standing than it used to. I think of otherACC patients I’ve met who have it muchworse than me. But I still resist whenpeople say that I’m brave or courageous.Not so. Bravery implies you’ve made achoice to do something. I did not choosecancer and cancer does not make mebrave. In fact, it often makes me crankyand impatient. I admire people who arealways positive, never complain and are aconstant inspiration to others. at’s notme. What I will admit to is being fierceand determined. It comes from anger,which is a negative place. But I’ve learnedto temper my anger by trying to helpothers, so if that’s the outcome, so be it.How do I cope? By playing the hand I’vebeen dealt. Does this make me lucky orunlucky? At the end of the day, I chooseto think Lady Luck is on my side.

For more information, visit Kathryn’s blog,www.ararecancerjourney.blogspot.com.

For more information on ACC, visitAdenoid Cystic Carcinoma OrganizationInternational, www.accoi.org and AdenoidCystic Carcinoma Research Foundation,www.accrf.org.

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Lucky or unlucky?By Kathryn SeeleyCancer Survivor

When people learn that I’ve been fightingmetastatic cancer for 15years, I’m often asked, “Howdo you cope with that? How do you stayso centered and positive?” My answerused to depend on my mood and theperson asking. But the truth was, inertia.What choice did I have? Yes, I try to bepositive and have a sense of humor, but Ireally have no choice about it. Whatcomes to mind is, “We play the handwe’re dealt.”

I was diagnosed in 2000 with a very raregland cancer called Adenoid CysticCarcinoma (ACC). It usually strikesglands in the head and neck – salivary,sinus, tongue, throat, neck, ears, eyes, youname it. But it can strike anywhere, andmine was in a breast gland (ACC of thebreast, ACCB), throwing me into thebreast cancer camp of medical treatment,where I stayed until 2006, when 10 lungtumors were found and I began toquestion everything. I had the usualbreast cancer protocol for a relativelysmall, low grade tumor: lumpectomy,radiation and chemotherapy “as aprecaution.” I was told I was cured.Lucky me! When the lung tumors werefound, I discovered research that myoriginal doctors should have found andapplied to my treatment six years earlier. I didn’t have breast cancer at all. After allthose support groups, pink swag, andspeeches I gave as a breast cancersurvivor... According to the NCI, justover 1,000 people in the U.S. a year get ACC. A fraction of these cases areACCB. It wasn’t until 2013 that I founda support group, any type of swag oranyone knowledgeable enough to give a speech.

As I set out on a lonely course to figureout how to stay alive, I learned that myprognosis was not so great. ACC growstoo slowly for any type of chemotherapyto be effective. It is unpredictable and it isrelentless. With no systemic option fortreatment, we are left to become our ownexperts and we often end up teaching ourdoctors about our disease. ACC travelsthrough the vascular system, looking for

nerves to destroy. Because of the vastsystem of nerves in the face, manyACC patients undergo numeroussurgeries, disfigurement andextensive reconstruction to achieve

control of this monster. epresenting symptoms are sodiverse and confusing, people

often have pain for years before anaccurate diagnosis is finally made. Andthis is only the first chapter. If it spreads,it usually spreads to the lungs and fromthere it’s anyone guess where it will showup. Treatment for metastatic ACCbecomes an exercise in guesswork andfaith. Not so lucky.

Since the first crop of lung tumors werefound in 2006, I’ve had three lungresections, 11 ablations (radiofrequencyand cryoablation) for 30+ tumors, andthree radiation treatment plans to kill andcontrol cancer in both lungs, rightkidney, soft tissue and a rib. In the midstof all this, I was diagnosed with AcuteMyeloid Leukemia (AML) in 2009,treated with high dose induction/consolidation chemotherapy, relapsed andreceived a donor bone marrow transplantin 2010. e “precautionary” chemo -therapy I received in 2000 as part of myinitial treatment for “breast cancer”caused secondary AML nine years later. I was given less than a 10% chance ofsurviving 12 months. After two years ofbrutal complications, often moredangerous than the AML, I recovered (I was really lucky!) and resumed the fightagainst a new crop of metastatic ACCtumors. (Cancel that.)

I left my full time job a year ago anddecided to move to Pittsburgh, where myclosest relative and best friend lives. I hadno family near me up until now, althoughI had a wonderful support networkaround the country. is last January, as Iplanned my move, I was diagnosed with athird cancer – breast cancer. e mostcommon type. e real, official, what-did-I-do-with-all-that-pink-swag, breastcancer. (Exit Lady Luck, stage left.) It wasin the same breast as the initial ACCtumor, and after a successful mastectomy,I received no further treatment. I movedto Pittsburgh on May 1st and although Ihave chronic pain, progressing diseaseand difficulty breathing, I love my newhome. I have much less stress and I

A new era of personalizedmedicineBy Jonas T. Johnson, MDChair, Department of Otolaryngology, Eye and Ear Institute

Doctors have always offered peoplepersonalized care. ey recognize thatindividual problems vary and it isacknowledged that patients often havediffering wishes. Nevertheless, a unitinggoal has usually been the need to succeedin treating the disease. If we use throatcancer as an example, treatment optionshave gradually changed as we have cometo understand this condition more clearly.Just a few years ago, squamous cell cancerof the mouth and throat was attributedalmost entirely to exposure to tobacco. Itwas somewhat of a revelation when about10 years ago, research was successful indemonstrating that some throat cancerswere actually due to the humanpapilloma virus (HPV). Cancers causedby tobacco had seemed to respondthrough either surgery or irradiation. ecancers caused by HPV appear to beespecially sensitive to the combination ofirradiation and chemotherapy. Scientistsnow have proven that the biologicdifferences among patients withsquamous cell carcinoma are even morecomplex. Literally dozens of differingmutations in the DNA of patients withcancer have been identified. is seems toexplain why treatment which may workvery well in one person may not beeffective in the next.

A patient we recently encountered withcancer of the mouth serves to illustratethis point. is man agreed to participatein a trial of biologic therapy before hehad surgery. e drug, which is approvedfor use in squamous cell cancer caused histumor to completely disappear. Beforeand after biopsies allowed our investi -gators to identify the mutation whichcaused his cancer. e drug he wasadministered targeted that mutation andcaused the cancer to regress. Unfortu -nately, the particular mutation expressedby this man’s cancer is present in only 1% of patients with squamous cancer ofthe mouth.

ese findings are exciting andimportant. It suggests that targeted

surgery to treat their head and neckcancer and asked them to evaluate sixcommunication tools, including threelaminated paper communication boardsand three communication apps on aniPad. e goal was to find the tools thatthey felt would be most useful and easy to use after surgery. Overall, participantsfound the laminated paper communi -cation boards to be the easiest to use butthey valued the voice output that two ofthe communication apps on the iPadprovided. Feedback that was particularlyhelpful to us was hearing that participantswanted more time and training to feelcomfortable with the iPadcommunication tools.

e tools that were selected byparticipants in the first phase of the studyare now being offered to participants overthe age of 60 who are scheduled toundergo head and neck surgery that isexpected to affect their ability to speakpost-operatively. Participants are providedtraining on the tools and the opportunityto practice with them prior to surgery.On the day of surgery, the tools theparticipants selected are brought to thebedside and set up for them. Participantsreceive daily communication support by atrained research nurse in order to helpfacilitate optimal use of the tools. Familymembers and nurses are also encouragedto utilize the communication tools withthe participants.

While we are still recruiting patients intothis study, the responses we have receivedso far have been encouraging. Participantshave described how the tools have helpedthem to communicate their urgent needs,like pain and the need to be suctioned,and they really appreciate being able tocommunicate messages to both theirfamilies and nurses.

While the focus of this study is on the useof tools by older adults, we hope toexpand the communication options andsupport to individuals of all ages in orderto optimize communication during atime when patients are particularlyvulnerable. In partnership with ourpatients, we are designing interventionsin order to improve the care we provide.We recognize that this is a difficult andstressful point in their illness – but theircontribution is so important.

therapy or “personalized medicine” is avery real possibility. It also suggests thatwe need to understand these tumors evenbetter. When the mutations which causedthe cancer can be reliably identified andtargeted, it offers the opportunity toprovide effective therapy to patients withtumors sensitive to that therapy. is alsooffers the opportunity to avoid treatmentwhich will not work. We remain optimisticthat findings such as these will lead toimproved outcomes for many people.

If I could only talk!By Marci Lee Nilsen, PhD, RNUniversity of Pittsburgh, School of Nursing

We typically think of patients andfamilies as recipients of care, but patientsundergoing surgery and their families areplaying a key role in helping improve carethrough their participation in innovativeresearch projects. rough a collaborationbetween e Department of Otolaryn -gology and University of Pittsburgh,School of Nursing, patients are involvedin progressive research that focuses onimproving the patient experience ofhaving surgery for head and neck cancer.

Patients who undergo surgical treatmentfor head and neck cancer can lose theability to communicate through oralspeech. While for some people, thisinability to communicate vocally istemporary, for others, this difficulty withcommunication can persist. During thepostoperative recovery period, patientsmust rely on alternative methods tocommunication – like pen and paper orgesturing. Many patients report difficultycommunicating their symptoms andneeds. is frustration is shared by thehealthcare providers caring for them andthe family members trying to supportthem. With funding from the NationalHartford Center of GerontologicalNursing Excellence and the MaydayFund, we are studying several alternativecommunication tools, and finding outhow easy and helpful it is for older adultpatients to use them in the immediatepost-operative period.

In order to find communication toolsthat work best for older adult patients, werecruited participants who recently had

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cardio. ink of walking, biking, swim -ming, etc. Be sure its fun too. Nothing is worse than feeling chained to a piece of equipment you dread getting on tobegin with.

2. Resistance training (RT)Any time you apply force to your musclescan be considered resistance training. isis a component which provides musclestrength, endurance, increased energy andincreased bone density. As we age, havingstronger muscles and bones can helpreduce the likelihood and severity of a slipand fall injury. You can use weighttraining machines, free weights, resistancebands, body weight, milk jugs or cans ofsoup. I get most of my equipment fromgarage sales and save versus buying new.

3. Flexibility and balance trainingI put these two together because far toomany people think we get worse at each aswe age. NO! We get worse at each becausewe do not train for them. Incorporatethem into a daily routine for best results.Yoga and Tai Chi are great substitutes forformal training exercises and can evenhelp with muscle endurance training.

4. PlanningMost people start exercising without anyplans. You need to plan your training tobe sure you are getting the most out ofyour sessions. Planning is key for RT,cardio, meals, supplements, shopping,relaxation and stress management,progression and recovery periods as wellas rewarding your successes.

5. Supportive dietKnowing how many calories to eat perday is just as important as knowing whatto eat. e meal planning guide I use withclients breaks the daily intake of caloriesinto 60% quality carbohydrates (mainly

fruits and vegetables), 30% qualityproteins and 10% good fats. Itdoesn’t have to be perfect

percentages but the qualityshould be the best mostof the time.

6. High quality nutri-tional supplementsYou may think there is

no difference in vitaminor mineral supplements.

And you would be verywrong. Buy cheap and you

will get what you pay for. But doesspending more always get you higherquality? No, unfortunately it does not.What you should look for is that formulaand product are produced in a cGMPcertified manufacturing facility. cGMP isdefined as current Good ManufacturingPractices and are now regulated by theFDA as part of the DSHEA in 1993. isguarantees that every formula is producedusing the best technology and utilizingthe highest quality control standards.What this means for the consumer is thatevery product is 100% guaranteed forpurity and potency.

I tell clients this: “If you want to eat beef,you can either go to McDonalds or toRuth’s Chris Steak House. My nutri -tionals are Ruth’s Chris quality.”

7. Sleep and stress managementSleep plays a vital role in managinghormone levels which can affect yourbody’s ability to shed stored fat weightamongst other system functions. Mostpeople are not getting enough sleep orquality sleep and it needs to be addressedfor balanced health and wellness. Stressmanagement is part of a good night’ssleep, but it’s also necessary to manageyour reaction to those things which stressyou. Our society has developed anattitude of one-upmanship to see who ismore stressed. It’s not a competition! Andif it is – the first one to the grave wins!Whaaaat?!! at’s crazy. Manage it nowbefore it alters your life completely.

And those are my seven key fitnessprogram components. I hope it helpsguide you towards a life of your designand management rather than a reactionto a life altered by poor health habits andchoices. Keep in mind, if you’ve hadhealth challenges, it’s never too late totake action in a positive direction.

Fred Como, BS, ownerof OneSource WellnessCoaching, is a certifiedPersonal Trainer andWeight Loss Specialistthrough the NationalAcademy of SportsMedicine. He can bereached at CoachFred@OneSourceWellnessCoaching.com, www.OneSourceWellnessCoaching.com or 724-713-1581.

Seven key fitness program componentsBy Fred S. Como, BS CPT, CWLS

In my 25 plus years of working in thehealth and wellness industry, there arecertain key factors I feel are very importantin client success. With respect to yourhealth, you might first consider noting adifference between wellness and fitness.

Wellness may be defined as a progressivelifestyle change which eliminates orreduces risks to our health and well-beingand enables us to balance emotional,spiritual, physical, intellectual, social andenvironmental well-being and bring us toa more satisfying quality of life.

Fitness, on the other hand, is an empiricalachievement of standards based on ageand sex. For example, e ideal body fatpercentage range for a female 45 years ofage is 21% to 25% (based on ACSMstandards). In many cases, I tell clients to“know your numbers” and the healthyrange you should work towards andmaintain. Most of these numbers you arefamiliar with such as blood pressure,cholesterol etc. Some not so familiar arebody fat percentage, waist and hipmeasures, flexibility, and cardiovascularendurance to name a few.

Knowing your numbers, and as muchabout your fitness levels and numbers is anideal platform to well established goals. Besure your goals are specific, measurable,attainable, realistic and timely. Having anumbers driven goal in mind can helpkeep you focused as well as motivated.

1. Cardiovascular trainingCardiovascular training, or simply cardio,is any type of activity or exercise which is related to or involving the heart andblood vessels. Cardiorespiratoryinvolves the heart, blood vessels and lungs and may be moreappropriate in termsof training andconditioning. Any activitywhich is 30 to60 minutes induration, andincludes mostlya sustained heartrate is considered

The healing journeyBy Karen ScuilliCancer Survivor

My name is KarenScuilli, the Founderand ExecutiveDirector of thenon-profitorganizationFace2Face Healing.

My journey began working as aregistered nurse turned case manager andclinical consultant, working for one ofthe largest insurance providers inPennsylvania. My life fit together like the pieces of a puzzle and I was bothprofessionally and personally satisfied and thriving.

I was diagnosed with a late stage parotidtumor on the right side on May 16th2012. e life I once knew was pulled

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apart as if a grenade had rolled into my“life puzzle” and shattered the life I oncelived. e pieces no longer fit. Some pieceswere too big, too small or even missing.

As I began creating a new “life puzzle”with all the shattered pieces, I stumbledacross a lot of barriers, both mentally andphysically. Like many of you, I sufferedmany losses such as the loss of myidentity with losing my job, my face andfinancial stability. I relied heavily on myfaith to get me through these last threeplus years. Don’t get me wrong, I did askGod why me? In fact, there were timeswhen I screamed it. But I knew that Godhad a plan for me. He needed me to helpothers with their journeys.

We all face adversity in some way oranother. It could be a disease such ascancer or other medical condition, theloss of a loved one, a divorce, loss of ajob, etc. When facing any loss, we tend tofocus on the loss instead of remindingourselves what we are grateful for. For me,I learned to be grateful for what I haveleft. is is not an easy process. Some -times it takes months or years. ere isno correct timeframe when dealing with a loss, no matter what anyone tells you. I still have my days when I cry and it isnormal. e important thing is to keepmoving forward and “fake it until youmake it.” You may not feel like doingsomething but do it anyway. en beforeyou know it, it will become part of yournew routine.

Having a strong support system is veryimportant. For me, some individualssupported me along my entire journeysuch as my family, a few close friends andmy church family. Other individuals werethere only when I needed them the mostand for that I am grateful. e otherindividuals that I like to call my “angels”,were the many nurses, physicians,physical therapists, massage therapists,dentists, dental hygienists, and newfriends I continue to meet along my carecontinuum. I initially pushed family andfriends away from me and tried dealingwith everything on my own. I beg younot to do this. It was not effective. Letyour family and friends help you as muchas possible. ey too are sharing in your

losses and letting them help is part oftheir healing process.

I have found many gaps along myjourney that have led me to my newmission, Face2Face Healing. Myexperiences allowed me to interface withthe healing process in ways I neverimagined. I have come to realize, alongwith many of my oncology and variousservice providers, that there are gaps inthe care and recovery models.

My goal is to involve individuals, theirfamilies and service professionals to joinan innovative healing network. Face2FaceHealing creates the support network togive individuals and their families dealingwith disfigurement the opportunity tomeet and share with others through inperson and on line support groups, aninteractive website and activity basedprograms. Face2Face Healing’s mission isto build a community for individualswith disfigurement to promote healingthrough outreach, interaction, activityand education. I invite you to participate.Come visit me at Face2FaceHealing.org.

5

Head & neck cancersupport groupA cancer support group, primarilyfor head and neck cancer patients,family members, and caregivers isavailable in the Pittsburgh area. e group meets the firstWednesday of each month atUPMC Cancer Center, Upper St.Clair, 200 Oxford Drive, Suite 500,Bethel Park, Pa. To register, call412-622-1212.

For additional topics on the prevention, detection and treat ment of cancer, including head and neck cancer, visit http://www.upmccancercenters.com/portal_headneck/publications.cfm for archived issues of Headway.

Head and neck cancer patients advocate for awarenessBy Jonas Johnson, MDChair, Department of Otolaryngology, Eye and Ear Institute

On Wednesday, April 22, 2009, a special program was presented for people concerned with recovery from head

and neck cancer. Over 40 head and neck cancer survivors and their families attended a presentation made by

Jeannette Ferguson, Ph.D. Dr. Ferguson is a scientist at the Ohio State University who has been treated for

mouth cancer. Her presentation, “A Head and Neck Cancer Journey: My Evolution from Patient to Advocate”,

detailed the excitement and potential benefits of advocacy in head and neck cancer. She described how some cancers, such as breast cancer and prostate, have received a great deal of attention from

the media. Famous people who are diagnosed with these cancers often work tirelessly to enhance the resources

that our society devotes to research that will reduce the incidence and improve the survival and quality of life

for individuals with these cancers. Head and neck cancer rarely receives such advocacy by celebrity testimonials

and seems to be a relative orphan disease in this environment. In addition to celebrities and politicians,

survivors of head and neck cancer do not have the experience organizing to fight this disease. �ere are no

Komen Foundations (which supports breast cancer research) or CapCUREs (which supports prostate cancer

research) dedicated to supporting head and neck cancer research on a large scale. Dr. Ferguson called attention to the fact that patients with head and neck cancer and their families must be

advocates for the importance of prevention, diagnosis, treatment, and rehabilitation in the field of head and

neck cancer. She urged the audience to be outspoken supporters for the importance of research in head and

neck oncology. Examples of activities could include writing to congress members to encourage support for

cancer research legislation and emphasizing that some resources, such as the state settlements from the tobacco

companies should be prioritized to study head and neck cancer, given the strong contribution of smoking to this

disease. Survivor groups can function both as support groups for the members as well as assist newly diagnosed

patients understand their treatment options and the importance of participating in clinical research studies.

Dr. Ferguson emphasized the important role that advocates can play as part of research programs to help the

investigators understand what is feasible and important for the patient and what is too challenging.�is program was an integral part of the UPMC program on Multidisciplinary Management of Head and Neck

Cancer, sponsored in part by the Specialized Program of Research Excellence (SPORE) in Head and Neck

Cancer of the School of Medicine. �is Head and Neck Cancer SPORE is one of only five such programs

supported by the National Cancer Institute (NCI) in the US.

Page 1Head and neck cancer patients advocate for awareness

Page 2Some free advice from a patient’sperspective

Introducing a new team memberinto the cancer care team

Page 3Head and neck radiation therapy –oral complications and itsrecommended dental care

Page 4Why am I so tired? Fatigue duringcancer treatment

Page 5The role of Brachytherapy in thetreatment of head and neck cancer

Page 6Call for participantsHead and Neck Cancer Program website

Contact information

H E A D WAYNEWS ON ADVANCES IN THE PREVENTION, DETECTION, AND TREATMENT OF HEAD AND NECK CANCERS

Summer 2009

at Cancer Cannot Do

�It cannot lessen love.

It cannot fracture faith.

It cannot hinder hope.

It cannot prevent peace.

It cannot crush confidence.

It cannot kill friendship.

It cannot keep out memories.

It cannot corrode courage.

It cannot shatter the soul.

It cannot quench the spirit.

It cannot stop resurrection power.

It cannot erode eternal life.

Author UnknownAdapted by June Hunt

Head and Neck OncologyEye & Ear Institute203 Lothrop Street, Ste. 300Pittsburgh, PA 15213P: 412-647-2100

Robert L. Ferris, MD, PhDUPMC Endowed ProfessorChief, Division of Head and Neck SurgeryCo-Principal Investigator, University of Pittsburgh SPORE grant

Jamie DeRussoHead and Neck SPORE Grant Administrator

University of Pittsburgh Department of Otolaryngology

Contact informationAmerican Cancer Society....................................1-800-227-2345Assistance with Coping..........................................412-623-5888Cancer Caring Center............................................412-622-1212Cancer Information and Referral Services..............412-647-2811Clinical Trials.............................412-864-1728 or 412-864-3759Eye & Ear Foundation...........................................412-383-8756Family Care Giver Education and Support ............412-623-2867Gumberg Family Library .......................................412-623-4733Head and Neck Cancer Support Group.................412-622-1212Hopwood Library at UPMC Shadyside.................412-623-2620Hyperbaric Oxygen Treatment...............................412-647-7480Our Clubhouse......................................................412-338-1919Pain and Supportive Care ......................................412-692-4724Project of Love (comfort pillows)...........................724-266-8007Prostate Cancer Support Group.............................412-647-1062Satchels of Caring Foundation...............................412-841-1289Swallowing Disorders CenterUPMC Eye & Ear Institute (Oakland) ................412-647-6461UPMC Shadyside ................................................412-621-0123

UPMC Division of Sleep SurgeryMercy ..................................................................412-232-3687Monroeville .........................................................412-374-1260

American Cancer Society website.........................www.cancer.orgHead and Neck Cancer Program website ...........................www.upmccancercenters.com/headneck Hillman Cancer Institute website .................www.upci.upmc.edu

Head and Neck Cancer Program websiteLooking for more information about patient services, currentresearch, clinical trials, news and events and other valuableinformation pertaining to head and neck cancers? Check out the website for the Head and Neck Cancer Program of UPMCCancer Centers at www.upmccancercenters.com/headneck.

Swallowing Disorders Centere UPMC Swallowing Disorders Center is dedicated in helpingpatients with swallowing problems as they undergo treatment forhead and neck cancer. Early intervention with swallowing exerciseshas been linked to better quality of life outcomes. It is highlyrecommended that patients be seen by the swallowing team tobegin a therapy program as soon as the plan for treatment hasbeen identified.

e process begins with a swallowing evaluation to assessbaseline swallowing function and to identify if posture changes,swallowing strategies, and/or diet modification will help thepatient swallow better. While some patients require a feeding tubeduring the course of treatment, the ultimate goal is to return toeating and drinking as soon as possible. We provide assistanceduring the transition from a modified diet or tube feedings backto a regular diet. When returning to a regular diet is not possible,we help to develop an individualized plan to take certain foodsor liquids safely.

We recently completed a study in which weekly questionnaireswere given to eleven patients as they underwent chemo-radiationtherapy to help us better understand what patients experienceduring the phases of treatment. is type of information is helpingus tailor our therapy approaches to achieve better outcomes. Formost, increased difficulty with swallowing occurs toward the endof treatment and may even last a few weeks after the completionof treatment. Once patients are feeling better, the goal is to re-establish the exercise program and begin aggressive interventionso patients can return to an oral diet safely. e team is alsoparticipating in a multi-center study involving a special device toexercise the tongue. e device measures baseline tongue pressuresso patients can improve strength with practice and meet specifictarget goals. Grip strength assessments are also being used in thecenter to determine if there is a relationship between weaknessand dysphagia (difficulty swallowing).

e UPMC Swallowing Disorders Center has two locations:• UPMC Eye & Ear Institute • UPMC Shadyside

(Oakland) • 412-621-0123412-647-6461

Clinical trialsFor more information about head and neck clinical trials,contact Amy at 412-864-1728 or Denise at 412-864-3759.