Reading Time: 3 minutes

Willamette Valley Cancer Institute and Research Center Welcomes Oregon Surgical Wellness/Winnie Henderson, MD, PhD, FACS and Christine Kollmorgen, MD, FACS

Drs. Winnie Henderson and Christine Kollmorgen bring a new line of treatment services, offering patients cutting-edge breast cancer surgery techniques and genetic cancer risk assessment.

Eugene/Springfield, OR — The Willamette Valley Cancer Institute and Research Center (WVCI) proudly announces a strategic partnership with Oregon Surgical Wellness (OSW), welcoming its distinguished breast surgeons Dr. Winnie Henderson, PhD, FACS and Dr. Christine Kollmorgen, FACS. Through the combination of cutting-edge breast cancer surgery, genetic cancer risk assessment, radiation oncology, medical oncology, advanced imaging and lab services, this collaboration will create a comprehensive cancer program for those diagnosed with breast cancer in our communities’. This unification will bridge gaps in patient care and transform a fragmented patient experience into a seamless journey.

“We’re excited to welcome Dr. Henderson and Dr. Kollmorgen to our team…at a time when we face a shortage of healthcare providers, this partnership will deliver support and expert care to those navigating a breast cancer diagnosis at a time when it’s needed most.” -Casey Chiasson, Executive Director, WVCI

With over 40 years of combined experience, Dr. Henderson and Dr. Kollmorgen bring a wealth of knowledge in breast disease and surgery. Their mastery of breast cancer biology, genetics, and advanced surgical techniques, such as oncoplastic and hidden scar breast surgery, offers patients the latest treatment advancements in a community-care setting, closer to home.

“This partnership will transcend and expand our comprehensive and innovative breast oncology program with a renewed focus on patient-centered care and patient empowerment. Our goal continues to be providing the most holistic and supportive personalized experience to every cancer patient throughout the cancer journey.” -Winnie Henderson MD, PhD, OSW breast surgical oncologist

Founded in 1997, the Willamette Valley Cancer Institute and Research Center (WVCI) has been a leader in cancer research, medical oncology, hematology, gynecologic oncology, and radiation oncology in the southern Willamette Valley and central Oregon Coast. The addition of breast surgeons to WVCI’s multidisciplinary team will help ensure that all aspects of a breast cancer patient’s care are considered and expertly managed.

“There’s no question that by combining our practices we have the opportunity to not only enhance the quality of care but ensure the continuity of care for the patients we serve.” -WVCI Medical Director, Corvallis.

Winnie Henderson, MD, PhD, FACS, CGRA has lived on the West Coast of the United States for the last 45 years. At Oregon Health & Science University, she obtained a Ph.D. in molecular microbiology and immunology and completed her medical and surgical training with a rural surgery fellowship in Oregon. Certified by the American Board of Surgery, Dr. Henderson specializes in general and breast surgery. She participates in several surgical quality registries and national committees to improve surgical outcomes. Dr. Henderson is certified by the School of Oncoplastic Surgery and Hidden Scar Breast Surgery Program to provide the best aesthetic surgical outcomes to her patients. In 2022, she was credentialled by City of Hope to provide genetic cancer risk assessment and management and became one of only four breast surgeons in the United States to be certified for Cancer Genetic Risk Assessment (CGRA) by the National Consortium of Breast Centers. She is passionate in revolutionizing surgical & cancer genetic care in our communities. Dr. Henderson is a fellow of the American College of Surgeons and member of several prestigious organizations, including Society of Oncoplastic Surgery, the American Society of Breast Surgeons, the American Society of Breast Disease, National Consortium of Breast Centers and City of Hope Clinical Cancer Genomics Community of Practice.

Dr. Christine Kollmorgen, MD, FACS is a Massachusetts native, who holds a BA in Biology from Dartmouth College and an MD from Boston University School of Medicine. Her background includes residency training at the Mayo Clinic, where she served as an associate professor and research fellow. Her sub-specialties include Breast Surgical Oncology and Endocrine Surgery. Dr. Kollmorgen is board-certified in Surgery and Genetic Cancer Risk Assessment. She is affiliated with many prestigious organizations, including being a Fellow of the American College of Surgeons, and a member of the American Society of Breast Surgeons, the American Society of Breast Disease, the Society of Oncoplastic Surgery, the National Consortium of Breast Centers and the City of Hope Clinical Cancer Genomics Community of Practice.

Dr. Henderson and Dr. Kollmorgen are currently seeing patients at Oregon Surgical Wellness, 3783 International Court, Suite 200, Springfield, Oregon. Timely appointments are available for newly referred patients. Please call 541.735.3778 to make an appointment. Physicians may fax 541.735.3772 to refer a patient.

About Willamette Valley Cancer Institute and Research Center

Since 1997, Willamette Valley Cancer Institute and Research Center has been a leader in advanced cancer treatments, serving the Willamette Valley and surrounding regions. As an affiliate of The US Oncology Network, WVCI is committed to offering innovative and integrated care, backed by cutting-edge technology and extensive clinical research. For more information, visit www.usoncology.com.

Media Contacts:

Christy Curtis | WVCI Liaison

541-632-3156

info@oregoncancer.com

Reading Time: 3 minutes

What is exercise oncology?

We all know that exercise is an essential component of health and wellness. There’s universal acceptance of the myriad of benefits of exercise, and there is consensus that physical activity improves virtually all aspects of life. Unfortunately, the robust data supporting the therapeutic benefits of exercise for cancer management and treatment has gone relatively unnoticed. Emphasis on and awareness of structured exercise programs in this specific sector of patients is lagging behind the science especially when compared to other medical diagnoses.

Compelling scientific evidence has emerged that moderate daily exercise improves multiple cancer related outcomes such as fatigue, quality of life, survival, and recurrence rates. There is an aerobic exercise goal recommended by the American College of Sports Medicine that patients ideally can strive to hit, but in recent years it has also been found that strength training is an equally important mode of exercise for patients. Incorporating two to three sessions of strength training is a great goal. As reported by the National Institutes of Health, women with breast cancer who met the minimum physical activity guidelines both before diagnosis and at the two-year follow-up (after treatment) had a 55% reduced chance of their cancer returning and a 68% reduced chance of death from any cause (not just breast cancer) compared with those who did not meet the guidelines at both times,” which is enough to motivate any individual to tie up their laces and go outside.

For primary and secondary prevention of cancer as well as moderate to strong effects on fatigue, anxiety, depression, quality of life, physical function, sleep, and bone health the following is prescribed: 150 to 300 weekly minutes of moderate-intensity aerobic exercise or 75 to 150 weekly minutes of vigorous aerobic activity along with twice-weekly progressive resistance exercise, including exercises for all major muscle groups.

Drs. Henderson and Kollmorgen at Oregon Surgical Wellness are committed to learning first-hand how to start a structured program and collect more data about the benefits of exercise in the setting of breast surgical oncology. While there are excellent exerciserelated survivorship programs here in Lane County, such as the LiveStrong program at the YMCA, wide accessibility to structured programs tailored to the cancer patient is still lacking and the development of additional programs is a natural progression towards the enhancement of the multidisciplinary care of patients experiencing cancer at any stage of their treatment journey. Not surprisingly, international guidelines have already been established that recommend counseling cancer patients about healthy lifestyle changes including exercise.

Despite these guidelines, there remains a reluctance from some physicians to prescribe exercise under these circumstances. Perhaps it is uncertainty about patients’ ability to tolerate exertion during treatment or simply a lack of knowledge in regard to the data supporting it.

Oftentimes, traditional expectations are for patients to rest during cancer treatments as they experience increased fatigue and stress. “With early adoption of these recommendations, OSW’s goal will be to facilitate the prescription of exercise as a community standard and it will hopefully become an integral part of our survivorship plan,” says Dr. Kollmorgen. The data is now clear, “promoting an active lifestyle with a focus on exercise while optimizing patient care will increase well-being and save lives by reducing recurrence rates.” The time is now to help facilitate patient and survivor engagement in exercise – there is no need to wait for a prior authorization.

How do we achieve patients’ buy in? There are several proven models to facilitate the implementation of exercise as part of the cancer care plan. These models range from clinically supervised settings to supervised and unsupervised community-based and online settings. Cancer care team members at every level also play an important role in promoting exercise to cancer survivors. Resources and tools are available to help the cancer care team motivate survivors to engage in exercise, such as enhancing enjoyment of the activity, goal setting, self-monitoring, and social support. Looking forward, gaining widespread community support is key to this initiative. In time, exercise oncology themes may even be infused into locally owned gyms and fitness centers. For the sake of our community’s cancer patients – “We like to move it!”

Reading Time: 2 minutes

Why you should ask about Aesthetic Flat Closure

It is always important to discuss your surgical plan and expectations with your breast surgeon before having a mastectomy. Mastectomies can create chest irregularities or leave excess tissue over the side of the chest known as “dog ears.” Some people may find these post-operative results unsightly or bothersome. When going flat, most of the overlying breast skin and  nipple are removed, ideally leaving a uniform, truly flat contour. Results can vary widely depending on a person’s body shape as well as the experience and mindset of your surgeon.

Aesthetic flat closure is a breast cancer surgery done by specialists who have an extra focus on mastectomy techniques. As community innovators, Drs. Henderson and Kollmorgen have been trained in oncoplastic procedures not just for preserving the shape of the breast during lumpectomy and hiding scars during reconstruction but also for patients choosing to go flat after mastectomy. An aesthetic flat closure may also be done after removal of a breast implant that was used to restore breast shape. During an aesthetic flat closure, extra skin, fat, and other tissue in the chest area are removed. The remaining tissue is then tightened and smoothed out so the chest wall looks as flat as possible. To accomplish this goal we use a number of techniques: V-Y plasty, tear drop incisions, waisted tear drop incisions, L-shape incisions or the Goldilocks approach.

Every chest is different so closures are all unique. Balancing your needs and expectations is an import part of your healing and treatment. For those choosing to embark on a flat chest journey here are a few online resources to explore.

Flat Closure Now

Going Flat After Breast Cancer

Fantastic Flat Fashions

Not Putting on a Shirt

Buddah Belly Support

Fabulously Flat

Sixty and Me

Wisdo.com

A recent study found that most women were satisfied with their flat closure results. However, 34% of women reported not receiving adequate information about their surgical options, and 20% did not feel their decision to go flat was supported by their surgeon. Some women even experienced “flat denial” which is when a surgeon denies their patient an agreed-upon flat closure either through negligence or disregard. This type of medical course is something that we at Oregon Surgical Wellness are committed to avoiding. At Oregon Surgical Wellness you have a voice and a choice. We respect the many reasons our patients choose aesthetic flat closure:

• shorter surgery
• faster recovery
• “one and done” surgery
• lower risk surgical complications
• avoiding a foreign body in their body
• no need for muscle or other tissue transfer (flap surgery)
• scars limited to the chest
• breasts that were causing health problems
• easier access to care due to limited plastic surgery coverage

Reading Time: 5 minutes

By Michael J. Asken, PhD, and Danielle E. Ladie, MD, MPH, FACS

Re-posted from General Surgery News, November 2021

It is obvious that optimizing the patient prior to surgery is essential for maximizing desirable outcomes. While these efforts typically focus on managing comorbidities and assessing physiologic parameters, “comprehensive” optimization is achieved by including attention to the psychological status of the surgical patient.

With evolving specialization in surgery and increasing sophistication of procedures, psychological evaluations have become integral in the evaluation of patients for certain operations, such as bariatric, transplant and pain-related orthopedic surgeries.^1,2 The benefits of psychological “preparation” of surgical patients has been proposed as an important consideration.^3,4

Less developed, in contrast to specialized psychological evaluations, is a simple and broad approach to assessing every patient’s psychological state in a manner appropriate for use by the surgeon involved in the case. Psychological preparation of the patient requires a first step of evaluation through a preoperative psychological survey (POPS).

While not an in-depth, diagnostic or psychopathology-oriented evaluation (hence the term “survey”), the qualitative POPS addresses a variety of areas of patient functioning that can bear directly on the quality and satisfaction of the surgical experience for both the patient and surgical team. A more specific and comprehensive evaluation may become indicated as a result of information elicited from such a general psychological inquiry.

There are two reasons why an assessment like the POPS is indicated: Surgery is a psychological, as well as physical, experience and psychological factors affect the surgical course, outcome and recovery.^5-10

Although the POPS could be delegated to another member of the surgeon’s team, we strongly suggest the surgeon engage the patient. We describe the POPS as a “discussion” with the patient that provides direct and useful information to the surgeon, illuminating issues that the surgeon will want to ensure are addressed. Perhaps, as importantly, this interaction can convey the sincerity of the surgeon’s concern for the patient’s overall well-being, enhance the perception of a positive bedside manner and bolster the quality of the surgeon–patient relationship.

When engaging the patient, the following items should be considered:

1. Discuss the patient’s perceptions of past surgical experiences.

The goal here is to illuminate psychological and emotional residuals (both positive and negative) that might still linger from those experiences. Did all go smoothly and as expected? Were there aspects that were uncomfortable, frustrating, angering or anxiety-arousing? What views of surgery—trust or fear—did past experiences create for the patient?

2. Discuss the patient’s view of others’ experiences with the same or similar procedures.

What has the patient heard from friends or relatives about the pending surgery? Are these stories exaggerated, especially in a negative way? The plethora of television medical dramas, social media commentary and internet (mis)information can influence a patient’s perception of their situation.

3. Discuss the patient’s understanding of their condition and need for the procedure.

The patient should have a substantial understanding of their condition, how the surgery will affect their condition and, consequently, a positive acceptance (if not enthusiasm) of the surgery. The reality is that patients do not always fully comprehend, or may be confused about, aspects of their condition and care.

4. Discuss the patient’s understanding of the procedure itself.

This is where you want the patient to tell you what they understand about their situation. What you told them is crucial, but what they heard, retained and understand is essential.

5. Discuss the patient’s short-term expectations.

Explore what the patient understands will happen going into the procedure, immediately after and in the ensuing 24 to 48 hours. Is there a realistic expectation of hospital length of stay, pain levels and fatigue? Discussion of postoperative sensations, such as stitches pulling, itching, numbness or oozing can be valuable. When these events occur unexpectedly, there is a tendency to interpret them in a negative manner (“my wound is tearing open!”).

6. Discuss the patient’s long-term expectations.

Ultimately, you want to hear that the patient has an accurate and reasonable expectation of time and any postoperative rehabilitation that is required. You want to listen for their understanding of what the procedure will accomplish and perhaps what it will not. Unrealistic expectations lead to a difficult postoperative course, strained interactions, disappointment and anger.⁶

7. Discuss current life stresses.

Stress is common, but a burned-out, dejected, pessimistic patient is not in an optimal state for surgery. While the acute need for surgery may preclude immediate intervention for stresses, their acknowledgment, especially with a commitment to help with follow-up postoperatively, can provide a sense of relief and a more optimistic outlook for the patient.

8. Discuss the patient’s usual way of coping with challenges.

A gentle, but effective way to approach this is by discussing how the patient usually deals with challenges and stressors. You might hope to hear approaches such as “I read up on things,” “I lean on my friends” and “My faith sustains me.” While usual perioperative support is still important here, such statements are a good foundation for the response to surgery. Responses like “I don’t know” and “I get pretty down” suggest a psychological infrastructure that would probably benefit from greater professional support.

9. Discuss current care and relationships with medical/nursing staff.

Despite best efforts, and for many reasons, patients don’t always perceive that they received the kind of care they expected. While never acceptable, frustration, anger, anxiety or fear of returning to a floor or team’s care is especially concerning going into surgery. A deteriorating relationship with staff is a risk for psychological morbidity.¹¹

10. Discuss current/past counseling history and assess mental status.

Discussion of these last areas often is the most difficult and sensitive for both the surgeon and patient. Generalizing problems with the term “stress” (everyone has it!) can reduce intrusiveness. Asking “how are you doing” is an effective way to start and listen for current, acute or ongoing anxiety or depressive thinking. Surgeon discomfort here should not be a rationale for avoiding this assessment. It is often extremely valuable as a baseline in the face of postoperative concerns like delirium and other cognitive changes.

The preoperative psychological assessment has the potential to provide important information to the surgeon for optimizing patient readiness for surgery. Obviously when concerns are revealed, addressing them in some manner from reassurance to psychiatric/psychological consultation is indicated.

The ability, interest and comfort of surgeons to engage productively in such discussions will vary greatly. We are not suggesting a prescription for how to evaluate a patient psychologically, but rather the value of generally increasing awareness of the patient’s psychological state and needs. Again, we differentiate POPS from in-depth psychological, neuropsychological or psychiatric evaluations that are essential in certain surgical scenarios and clinical situations.

What is suggested is a thoughtful discussion with the patient. The content and extent are to be determined by each individual surgeon and situation. Some patients (with an avoidant coping style) will be reluctant to engage fully and they should not be pressed.³ However, completing a POPS through discussion allows an opportunity for unique concerns to emerge while cultivating the relationship.

References

1. Block A, Sarwer D, eds. Pre-surgical Psychological Screening: Understanding Patients, Improving Outcomes. American Psychological Association; 2012.
2. Kumnig M, Jowsey-Gregoire S. Pre-operative psychological evaluation of transplant patients: challenges and solutions. Transplant Res Risk Manage. 2015;7:35-43.
3. Johnston M, Vogele C. Benefits of psychological preparation for surgery: a meta-analysis. Ann Behav Med. 1993;15(4):245-256.
4. Salzmann S, Salzmann-Djufri M, Wilhelm M, et al. Psychological preparation for cardiac surgery. Curr Cardiol Rep. 2020;22:172.
5. Burton D, King A, Bartley J, et al. The surgical anxiety questionnaire: development and validation. Psychol Health. 2019;34(2):129-146.
6. Cody EA, Mancuso CA, Burket JC, et al. Patient factors associated with higher expectations for foot and ankle surgery. Foot Ankle Int. 2017;38(5):472-478.
7. Orri M, Boleslawski E, Regimbeau JM, et al. Influence of depression on recovery after major noncardiac surgery: a prospective cohort study. Ann Surg. 2015;262(5):882-889.
8. Rasouli M, Menendez M, Sayadipour A, et al. Direct cost and complications associated with total joint arthroplasty in patients with pre-operative anxiety and depression. J Arthroplasty. 2016;31(2):533-536.
9. Ghoneim M, O’Hara M. Depression and post-operative complications: an overview. BMC Surg. 2016;16(5). doi:10.1186/s12893-016-0120-y
10. Nixon D, Schafer K, Cusworth B, et al. Preoperative anxiety effects on patient-reported outcomes following foot and ankle surgery. Foot Ankle Int. 2019;40(9):1007-1011.
11. Williams H, Jajja M, Baer W, et al. Perioperative anxiety and depression in patients undergoing abdominal surgery for malignant disease. J Surg Oncol. 2019;120:389-396.

---

Dr. Asken is the director at Provider Well-Being, UPMC Central PA Region, Harrisburg, Pa. Dr. Ladie is a transplant surgeon and the vice chair, Department of Surgery, UPMC Central PA Region, Harrisburg, Pa.

Reading Time: < 1 minute

Telemedicine delivers the highest quality medical care right to the comfort of your home. Scheduling a Telehealth appointment allows you to connect with our Wellness Surgeons at the touch of a button on your phone ipad or computer. Many surgical consultations can be safely and effectively completed online, and we encourage our patients to see how telemedicine can benefit them.  Telehealth is a fast and efficient way to get a second opinion and we welcome any opportunity we have to help you feel solid about your treatment decisions. 

After launching our telemedicine capabilities due to COVID, we’ve noticed a very positive response. We plan to keep using and  improving this vital service.  Patients are thrilled they can receive the highest quality care without long commutes, days off work, and waiting rooms. Additionally, we’re grateful that we’ve become more accessible to serve communities far from our practice.

Feel free to reach out by email info@oregonsurgicalwellness.com to make an appointment.