California Pacific Medical Center

A Higher IQ for Cancer Care at Sutter

Posted on Apr 20, 2020 in California Pacific Medical Center, Innovation, People, Quality, Research, Transformation

Machine learning for cancer research

To learn how Sutter cancer researchers are applying machine learning to cancer care, we interviewed John Chan, M.D., a gynecologic oncologist at Sutter’s California Pacific Medical Center (CPMC) and Palo Alto Medical Foundation, and the Denise & Prentis Cobb Hale Endowed Chair in Gynecologic Oncology Research.

John Chan, M.D.

How might artificial intelligence (AI) be used to improve cancer care?
AI builds smart machines capable of performing tasks that typically require human intelligence like learning, reasoning and problem-solving skills. We already see AI playing a key role in our daily routines and our interactions with media, transportation and communications.

With a surge of new knowledge in this area, researchers are applying AI and machine learning to innovate healthcare with improved diagnoses and treatment. As machine learning algorithms are exposed to more data—in some cases gleaned from the electronic heath record (EHR)—they can detect hidden patterns within data that can be used to perform a task without sophisticated programming.

Given the large number of Americans diagnosed with cancer and the huge volume of data generated during cancer treatment, there is a growing interest in using AI and machine learning to improve cancer care.

How are you applying AI and machine learning to your gynecologic oncology practice at Sutter?
Through a collaboration with the University of North Carolina and The Medical College of Georgia at Augusta University, we’re using machine learning to classify cancer patients into high- or low-risk groups, and to personalize sub-groups of uterine cancer patients who may or may not benefit from chemotherapy. Our research resulted in a clinical calculator that was described in Gynecologic Oncology.

The findings suggest a clinical calculator can help predict benefit and risk of chemotherapy treatment in patients with uterine cancer. And now we’re expanding the machine learning tool to study advanced-stage cancers and gynecologic diseases like ovarian cancer.

We plan to share the clinical calculator with providers across Sutter and with peer institutions that care for gynecologic cancer patients who live in more remote communities, or who are otherwise unable to travel to larger cancer centers. That way, more cancer patients may benefit from the research underlying this new AI-based tool. This could help increase access to safer and more effective cancer treatments, and reduce healthcare costs.

What are the potential benefits of using AI and machine learning to guide oncology treatment decisions?
Machine learning can “free think” creatively because it’s not confined by pre-existing human biases that may be present in routine clinical practice. This and other AI approaches like deep learning can help us determine levels of risk and benefit associated with various cancer treatments.

For example, an older patient with ovarian cancer may be at increased risk of treatment-related complications compared with younger patients. AI can identify risk profiles to help guide treatment decisions based on data from similar sub-groups of cancer patients.

In clinical oncology, AI has increasingly been applied to harness the power of the EHR. Specifically, AI-based natural language processing techniques may help predict the development of diseases across large healthcare systems.

At Sutter, our integrated network enables access to EHR and outcomes data from a highly diverse patient base. Machine learning can find associations and calculate risk scores to better predict treatments that will provide optimal benefit and reduced risk of treatment-related complications or adverse effects. This approach may become a new decision tool that we can add to our clinical toolkit and share with collaborators across Sutter.

Cancer care and research at Sutter: High “CQ” using machine learning:

Other Sutter physicians, researchers, and innovators across the system are applying AI to cancer care and elsewhere. Here’s how:

  • Earlier this year, Sutter partnered with Bay Area startup Ferrum Health to develop machine learning algorithms for early detection of lung cancer at radiology clinics in Sacramento. Ferrum’s AI platform read 10,000 CT scans and reports. Within 90 days, it flagged 83 cases in which it detected a mass of tissue on the scan that was not mentioned in the report.
  • Albert Chan, M.D., M.S., Sutter Health chief of digital patient experience, is leading digital transformation efforts across Sutter. He oversees a unified digital patient engagement and virtual care strategy, including leadership of Sutter’s patient portal My Health Online, telemedicine and artificial intelligence-powered solutions.
  • Through a collaboration with Stanford Medicine, Sutter Health systems researchers will launch the Oncoshare Project using a “big data” approach to improve breast cancer care. Oncoshare enables researchers to generate high-resolution maps of breast cancer treatment, and identify care pathways that yield the best outcomes for patients.

Learn more about Sutter research and clinical trials.

Could an Experimental Drug Studied for Ebola Work Against COVID-19?

Posted on Apr 8, 2020 in Affiliates, California Pacific Medical Center, Community Benefit, Expanding Access, Innovation, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Santa Rosa Regional Hospital

Not-for-profit Sutter Health Launches Clinical Trials with Gilead Sciences

clinical trials for Covid-19

Sutter Health, together with health systems across Northern California has teamed up with Foster City-based Gilead Sciences on clinical trials for a promising treatment for COVID-19. The COVID-19 vaccine is at least a year away and now scientists across the globe are investigating existing medicines that might work as treatments.

In April 2020, Sutter began participating in two of Gilead Sciences’ Phase 3, randomized clinical trials to evaluate the use of the company’s drug, remdesivir, in adults diagnosed with COVID-19, the disease caused by the novel coronavirus.

The studies test the clinical efficacy and safety of remdesivir in patients with moderate or severe COVID-19, compared with standard-of-care treatment. The U.S. Food and Drug Administration (FDA) reviews results from Phase 3 trials when considering a drug approval.

Promising Treatment
Remdesivir is an antiviral, intravenous drug made by Gilead Sciences. It’s been available as an experimental compound for years, but has not been approved by the FDA for use in clinical treatment.

Jamey Schmidt, Director of Clinical Research at Sutter’s California Pacific Medical Center (CPMC), quickly saw the potential benefit to patients in partnering drug manufacturers (in this case, Gilead Sciences) with Sutter researchers and physicians skilled in clinical trial start-up and ready to help tackle the infectious disease outbreak.

“Sutter research is committed to bring this investigational treatment to Sutter physicians caring for patients infected with the novel coronavirus,” says Schmidt, who collaborated with Greg Tranah, Ph.D., CPMC’s Scientific Director, and Jennifer Ling, M.D., infectious disease specialist at CPMC and principal investigator of the remdesivir clinical trials at CPMC.

CPMC, Sutter Santa Rosa Regional Hospital, Sutter Roseville Medical Center and Sutter Medical Center Sacramento are participating in the clinical trials of remdesivir, and other Sutter sites may enroll to the studies later this month.

“In response to this global health crisis, we’re proud that Sutter is helping lead efforts across Northern California and seeking new tools to combat this novel infection and lessen the virus’s impact,” says Dr. Ling. “Through research at Sutter, new discoveries will help determine the potential of remdesivir to help individual patients with COVID-19.”

Some patients who have been infected by the novel coronavirus and are severely ill may not meet the study criteria for enrollment in the clinical trials of remdesivir. Instead, they may qualify for treatment via Gilead Sciences’ expanded access program (EAP) for remdesivir. The EAP provides alternative access to the investigational drug for severely ill patients with COVID-19 who do not meet the clinical trials study criteria.

First developed in 2009 and used during the Ebola outbreak in 2014, remdesivir is being studied in multiple clinical trials worldwide to see if it is safe and effective against the coronavirus in humans. The drug was previously tested in animals infected by other coronaviruses like SARS and MERS, and is now being tested in humans to determine if it can reduce the intensity and duration of COVID-19.

“Research at Sutter is helping deliver safe, high-quality care to our patients during this unprecedented pandemic,” says Leon Clark, Vice President, Chief Research and Health Equity Officer, Sutter Health. “By bringing innovation to the forefront of how we can best care for Sutter patients who acquire COVID-19, Sutter’s talented researchers are stepping up to the challenge presented by this global health crisis.”

April 29 Update:
Results from a clinical trial of remdesivir, an antiviral manufactured by Gilead Sciences, led by the U.S. National Institutes of Health (NIH) were reported April 29, 2020. The findings suggest that hospitalized patients with advanced COVID-19 and lung involvement who received remdesivir recovered faster than patients who received placebo, according to a preliminary data analysis from a randomized, controlled trial involving 1063 patients. The trial (known as the Adaptive COVID-19 Treatment Trial, or ACTT), sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, was the first clinical trial launched in the United States to evaluate remdesivir as an experimental treatment for COVID-19.

Additionally, Gilead Sciences also shared preliminary results today from the company’s open-label, Phase 3 SIMPLE trial evaluating five- and 10-day dosing durations of remdesivir in hospitalized patients with severe COVID-19. The study results demonstrated that patients receiving a 10-day treatment course of remdesivir achieved similar improvement in clinical status compared with those patients who were administered a five-day treatment course of the drug.

Sutter is not participating in the ACTT treatment trial nor the SIMPLE clinical trial. However, as described in the above article posted on April 8, Sutter is participating in the two Phase 3, randomized, controlled clinical trials that are testing remdesivir. Gilead Sciences has not yet disclosed when results of these clinical trials will be published. Clinical trials at Sutter testing investigational use of remdesivir will close to enrollment May 29, 2020.

May 4 Update:
On May 1, 2020, remdesivir received FDA Emergency Use Authorization for the treatment of COVID-19. The authorization enables the potential use of remdesivir to treat hospitalized patients suffering from severe COVID-19 disease in the U.S., outside of the context of an established clinical trial of the drug. Based on patients’ severity of disease, the authorization allows for five- and 10-day treatment durations.

Learn more about Sutter research and clinical trials.



Special Delivery: Mobile Clinic Brings Healthcare to S.F.’s Homeless

Posted on Apr 7, 2020 in California Pacific Medical Center, Community Benefit, Expanding Access, Scroll Images

SAN FRANCISCO—Imagine if you were ordered to shelter in place and your only option was a homeless shelter. How would you get care for your existing health conditions?

For low-income or homeless people who live in San Francisco’s Tenderloin neighborhood, the coronavirus outbreak is making what was already a difficult situation even more challenging. Fortunately for Tracey Gamedah, who suffers from mobility issues due to high blood pressure and congestive heart failure, the recently-launched HealthRIGHT 360 Mobile Healthcare Service brings the primary care she needs to her neighborhood, close to the women’s shelter where she is staying.

Watch Tracey Gamedah’s story:

“Sutter Health provided tremendous financial support to launch the medical mobile van and bring medical service to the vulnerable population right here on the streets of San Francisco,” says HealthRIGHT 360’s Stephanie Yeh, P.A., who cares for Gamedah.

Says Gamedah, “You can’t give up hope. I just knew that if I kept going that I would find help and I found it when I saw that truck outside.”

The HealthRIGHT 360 Mobile Healthcare Service is a collaborative effort with major support from Sutter’s California Pacific Medical Center (CPMC). Read more.

‘Rockin’ It: Art Helps Cancer Patient Find Healing and Purpose

Posted on Mar 17, 2020 in Affiliates, California Pacific Medical Center, People, Wellness

SAN FRANCISCO – “Life is tough, but so are you.”

This powerful message is hand painted onto a smooth, palm-sized stone that rests at Sutter’s California Pacific Medical Center’s Van Ness Campus kindness rock garden in San Francisco.

But it won’t be there for long.

Someone who needs it will pick it up and take it with them.

That’s the idea behind the hospital’s rock garden, located on the facility’s fifth floor terrace. Here, stones with inspiring messages and colorful scenes are on constant rotation as patients, staff and visitors are encouraged to “take one, share one, leave one.”

This simple yet meaningful concept struck a chord with Cameron Yee, a nursing student who found herself at CPMC, part of the Sutter Health not-for-profit network of care, when her cancer returned.

Cameron Yee visits CPMC Van Ness Campus hospital’s Rock Kindness Garden.

Yee was diagnosed with rhabdomyosarcoma, a rare type of cancer that forms in the body’s soft tissue, at 18. She went into remission in 2016 and began feeling the cancer’s symptoms again in October 2019.

Yee was admitted to CPMC in late 2019 due to a complication from her chemotherapy and radiation. Her oncologist suggested a visit by the medical center’s expressive arts therapist, Jane Siegel.

Siegel introduced Yee to painting rocks as a form of mindfulness, self-care and an outlet to distract her from pain. It was the perfect non-medicinal prescription for Yee’s creative mind.

A “You’ve Got This” kindness rock was the first she took from CPMC’s garden.

“This rock kept me grounded and hopeful. It was one of the things that gave me strength and motivation to keep on going. I am forever grateful for the person who painted this rock,” said Yee.

Yee has taken to painting rocks like Monet took to painting watercolors. She was hooked—and more importantly, uplifted.

Yee paints concentric hearts onto a heart-shaped stone.

“Cameron is our rock star of rock art,” laughs Jane Siegel. “Art therapy is an outlet that offers true health benefits and stress relief for patients and staff alike. It’s deeply rewarding as well as healing.”

Now, months later, Yee has started an effort called ‘Rock Kindness’ to help populate CPMC’s rock garden and grow the rock kindness community at large.

Each month, Yee drops off a new series of rocks. Some of her themes have included “You’ve got this” and “Nobody fights alone.”

She has also started an Instagram page, @rock.kindness, where followers can learn about journey and see her latest designs and motivational messages.

At 21, Yee’s in her final semester of nursing school at Dominican University of California and shadowing a nursing preceptor at CPMC.

“I hope to become a pediatric nurse or specialize in something where you can see more chronic patients,” she says.

Yee keeps her “You’ve Got This” rock on her nightstand, where it serves as a reminder of a moment when the exact message she needed, was delivered to her at the exact right time.

Yee knows that no matter what curve ball life throws her way, SHE’S GOT THIS!

An Endgame for Epilepsy

Posted on Mar 13, 2020 in California Pacific Medical Center, Innovation, Neuroscience, People, Quality

One man’s struggle with seizures is silenced thanks to a medical device implanted on his brain.

Reno, Nev. — Andy Fiannaca, a college student at the time, first discovered he had epilepsy when he woke up in an ambulance. His head was gouged and bleeding—the result of falling during an intense epileptic seizure. Even with no family history of epilepsy, Fiannaca would soon learn that is exactly what he had.

For years, severe daily seizures affected his quality of life, limiting his activities. He experienced speech problems, such as difficulty finding and forming words, and would often lose the ability to comprehend what people around him were saying, known as aphasia. Everything became a foreign language.

Andy Fiannaca displays his post-surgery scar from where his RNS device was implanted.
Andy Fiannaca’s surgery scar is on full display where his RNS device was implanted.

Fiannaca also suffered from the “Alice in Wonderland” syndrome. During episodes, his visual perception would become drastically distorted. He was either an ant looking up at giants, or a giant looking down at ants. Driving a car was out of the question, and continuing his studies at the University of Nevada, Reno became increasingly difficult.

To control his seizures, Fiannaca tried six different medications and then a surgery in which a series of shallow cuts were made in his brain tissue. The goal was to remove the part of the brain where his seizures originated. Unfortunately, his Reno surgeons found the source was too close to his speech center. His symptoms improved after the surgery, but within two years they returned.

Clearly, Fiannaca required more advanced help. But since he lives in Sparks, Nevada (outside Reno), where this level of advanced neurology is not available, his care team finally referred him to California Pacific Medical Center (CPMC) in San Francisco, part of the Sutter Health not-for-profit network of care.

At CPMC, neurologists David King-Stephens, MD and Peter Weber, MD, recommended the RNS System, an implanted device designed to continuously monitor brain activity, detect abnormal patterns and intervene to stop seizures before clinical symptoms appear. It is the first and only medical device that can monitor and respond to brain activity. This treatment, Fiannaca says, ultimately changed the course of his life.

The Fiannaca Family
The Fiannaca Family.

Since Fiannaca had the RNS device implanted six years ago, his seizures have radically reduced. He hasn’t had a grand mal seizure in two years, and he’s finally able to drive a car again. His wife Sara has been by his side through it all. The couple worried for a long time that epilepsy would prevent them from starting a family, but with his condition now under control, Fiannaca and Sara welcomed their first child 18 months ago.

Epilepsy is a widespread condition characterized by recurrent seizures that often causes a severe impact on a person’s quality of life. It affects as many as one in 26 adults in the U.S., and in 50 percent of epilepsy cases, the cause is unknown.

Epilepsy Awareness Day is March 26, 2020.

Helping Mind the Gap on Cardiovascular Diseases

Posted on Feb 7, 2020 in Alta Bates Summit Medical Center, California Pacific Medical Center, Cardiac, Expanding Access, Innovation, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento, Sutter Medical Foundation, Sutter Roseville Medical Center

Heart valve imaging
Heart valve imaging

Lifesavers appear in big sizes and small. For patient Adam Livingstone, rescue was a dime-sized clip that restored his heart’s normal rhythm and size. For months, Livingstone had been experiencing shortness of breath, chest pain and fatigue. Diagnosed with mitral valve regurgitation, a minimally invasive procedure to repair the valve was performed at Sutter Medical Center, Sacramento—one of Sutter’s sites where researchers evaluate new devices for treating damaged or diseased heart valves.

The Heart’s Finely Orchestrated Blood Flow

Heart valves
Heart valves

Like a musical conductor, the heart oversees rhythm and flow, circulating blood to each of its chambers in a coordinated, unidirectional symphony.

THE MITRAL VALVE

Mitral regurgitation, the most common type of heart valve disorder, occurs when blood leaks backward through the mitral valve when the left ventricle closes.

Some patients undergo non-surgical heart valve repair with transcatheter mitral valve repair (TMVR) with MitraClip®.2 During the procedure, doctors thread a catheter into a large leg vein reaching the heart. Then a dime-sized clip clamps the improperly working valve, allowing it to close more tightly with less backward blood flow.

“Some research participants recover faster and resume normal activities within a week of the procedure, and may not require lifelong anticoagulant medications, repeat surgeries, or re-hospitalization,” says David Roberts, M.D., FACC, FSCAI, medical director of cardiovascular services at Sutter in the Valley Area.

A new clinical trial at Sutter called PASCAL CLASP IID/IIF will test the safety and effectiveness of TMVR with the PASCAL Transcatheter Valve Repair System® compared with MitraClip® in patients with mitral regurgitation.3

For patients with severe mitral regurgitation, Sutter’s CPMC seeks to enroll patients in a clinical trial called SM3, which assesses the safety and efficacy of the SAPIEN M3 System™.4

“In this study, we are evaluating a new type of mitral valve that may provide a minimally invasive alternative to surgery for high-risk patients with severe mitral valve disease,” says David Daniels, M.D., co-director of Sutter’s Structural Heart Program in the Bay Area, and principal investigator of the SM3 clinical trial at Sutter.

Some patients develop mitral valve disease when calcium deposits accumulate on the fibrous ring attached to the mitral valve leaflets. For these patients with mitral annular calcification (MAC), Sutter will begin offering enrollment in the Summit clinical trial, which will test the safety and effectiveness of the Tendyne™ transcatheter mitral valve.5

“Previous approaches to treat patients with MAC have mainly involved the off-label use of transcatheter aortic valves,” says Dr. Roberts. “But this strategy may lead to residual mitral regurgitation and the need for open-heart surgery. Sutter’s participation in Summit may lead to novel ways to care for this hard-to-treat subset of patients.”

THE TRICUSPID AND AORTIC VALVES

Although a skilled conductor, sometimes the heart needs help to maintain proper blood flow for musical perfection. To the rescue: Sutter researchers test interventional devices designed to treat patients with diseased or damaged tricuspid and aortic valves.

In one new clinical trial, Sutter researchers will collect information about treatment for severe aortic regurgitation, a condition typically treated with aortic valve replacement surgery.

This study will examine the use of TAVR (Transcatheter Aortic Valve Replacement), a minimally invasive procedure designed to replace the aortic valve inside the heart. In this study, TAVR will be performed using the JenaValve™ Pericardial TAVR System, designed to help treat patients with severe aortic regurgitation or severe aortic stenosis.6

“Until now, all commercially available TAVR valves have focused on aortic stenosis, or a restricted valve,” says Dr. Daniels, co-principal investigator of the TAVR with JenaValve™ clinical trial at Sutter. “The JenaValve™ may allow researchers to treat patients with a leaky valve in the absence of any calcium. Currently these patients are only candidates for open-heart surgery.”

Additionally, Sutter researchers at CPMC and Sutter Medical Center are seeking to enroll patients who have tricuspid regurgitation in a clinical trial called TRILUMINATE.

The TRILUMINATE study will evaluate the safety and effectiveness of the Tricuspid Valve Repair System™ (TVRS) for treating moderate or severe tricuspid regurgitation in patients currently on medical management and who are deemed appropriate for percutaneous transcatheter intervention.7

  • Learn more about Sutter cardiovascular diseases research and clinical trials.
  • If you are suffering from mitral or tricuspid valve regurgitation, aortic valve stenosis or other heart valve disorder, talk to your cardiologist to see if research participation and/or valve replacement or repair is right for you.

References:

  1. American Heart Association.
  2. MitraClip™ is manufactured by Abbott Medical Devices.
  3. The PASCAL clinical trial is sponsored by Edwards Life Sciences, makers of the Transcatheter Valve Repair System®.
  4. The S3 clinical trial is sponsored by Edwards Life Sciences, makers of the SAPIEN M3 System™.
  5. The Summit clinical trial is sponsored by Abbott Medical Devices, makers of the Tendyne System™.
  6. The JenaValve™ clinical trial is sponsored by JenaValve Technology, Inc., makers of the Pericardial Transcatheter Aortic Valve Replacement (TAVR) System.
  7. The TRILUMINATE clinical trial is sponsored by Abbott Medical Devices, makers of the Tricuspid Valve Repair System™.