Dr. Bobbie Sutton adds to her credentials in Molecular Genetic Pathology

The Medical Foundation’s Dr. Bobbie Sutton, a pathologist and Director of Molecular Pathology, has recently passed her Maintenance of Certification Part III examination in Molecular Genetic Pathology. This achievement fulfills the 10 year requirement for maintaining an accolade she earned years ago.

It all began in July of 2006, when The Medical Foundation sponsored her training at the University of Oklahoma Health Sciences Center (OUHSC) where she completed a fellowship in Molecular Genetic Pathology.

At the time, The Foundation knew that molecular diagnostics was a rapidly expanding field and with so many changes on both the clinical and anatomic sides of pathology, they needed someone to take the reins and master the discipline.

Dr. Sutton did just that. Following the one year fellowship, she successfully passed the Molecular Genetic Pathology Subspecialty board certification exam in September of 2007.  But passing this exam hardly meant that she was finished learning.

“This field is very demanding.  Keeping up with the medical genetics literature, as well as all the new technology that impacts our testing, is something that really keeps me on my toes.  However, I am confident that participating in the Maintenance of Certification process and monitoring trends and best practices in the industry, will help me to keep our molecular pathology lab ahead of the curve,” said Sutton. 

Each year, she must complete 70 hours of continuing education modules, 20 hours of self-assessment module credits, and to maintain her certification she must also keep her full medical license, as well as active medical privileges.  In addition, to the yearly maintenance, she must complete lengthy recertification exams every 10 years, such as the one she passed this March.

Oversight of the examination is shared by The American Board of Pathology and The American Board of Medical Genetics, which ensures that diplomats, such as Dr. Sutton, are competent in the following six areas: patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

According to the American Board of Medical Science (ABMS), Dr. Sutton stands among only 265 pathologists who have been certified in Molecular Genetic Pathology.

Dr. Sutton’s knowledge and expertise in the field led to increased test offerings in the Flow Cytometry/ Molecular Pathology department at The Medical Foundation. 

Most recently, The Foundation joined efforts with Harper Cancer Research Institute (HCRI), Beacon Health System and St. Joseph Health System to bring state-of-the art testing to the region, concentrating in areas of colorectal cancer, melanoma and lung cancer.

New instrumentation acquired in early 2014 will analyze a small sample of DNA from tumor cells and identify up to 105 mutations in one reading.  Such mutations can determine which chemotherapy drugs are most likely to be effective.  This allows pathologists and oncologists to spare patients unnecessary treatment-associated toxicity by a drug that is unlikely to affect their particular tumor. 

“This is what patient centered care is all about. It’s my hope that this will help patients who need genetic data to get the optimum treatment for their cancers,” said Sutton. 

As the field of Molecular Genetic Pathology continues to rapidly advance, one thing remains constant: The Medical Foundation’s Dr. Bobbie Sutton will continue to learn and add to her expertise in the field, while she shares her expertise with her colleagues and physicians in the communities served by the Foundation.

Transfusion Thoughts with Dr. Bobbie Sutton

We have known for decades that blood transfusion is a life-saving medical intervention.  Just ask any survivor of severe traumatic injury, a complicated surgical procedure, or cancer, where necessary chemotherapy slowed the body’s ability to replace oxygen carrying red blood cells, infection fighting white blood cells or hemorrhage stopping platelets:  Transfusion saves lives.  However, an accumulating body of data also shows that there are significant risks associated with transfusion, and in some circumstances, those risks may outweigh the benefits.  For example, a large meta-analysis of transfusion data published in early 2014 in the Journal of the American Medical Association found that a restrictive approach to transfusion, i.e., giving less blood rather than more, was safer for many patients.  These researchers found that the risk of serious hospital-acquired infection was lowered substantially among patients whose doctors ordered a blood transfusion at a lower hemoglobin level, compared with those whose caregivers used a higher cutoff [1].  For surgical patients, blood transfusion has been associated with more postoperative pulmonary and infectious complications, prolonged ventilator support, and higher mortality.

In response to these and other data, today there is broad recognition that we should improve overall  patient blood management.   Broadly defined, patient blood management is an evidence-based, multidisciplinary process that is designed to promote optimal use of blood products in the hospital.  This concept places patient safety first, and includes transfusing only when medically necessary, thus potentially reducing overall patient morbidity and mortality.  In the cost conscious medical environment of today, a secondary goal of blood management is reduction of costs associated with treating any adverse events we now understand could be associated with transfusion, as well as just not having to collect, process and transfuse as much blood.   

Throughout the state, many of the hospitals we serve have embraced patient blood management.   At one hospital, posters reminding physicians to carefully consider transfusion requests are prominently displayed in physician elevators and other areas.  At another, blood utilization and management data spanning several years was published as an abstract at the AABB 2013 national meeting, entitled  “Reducing Platelet and Red Blood Cell Utilization in a 325 Bed Hospital” [2; on display, 4^th floor, Main Lab TMF].   Dr. Bobbie Sutton, Medical Director of Blood Donor Services and Blood Bank Services at The Medical Foundation, has lectured about Blood Management to multiple groups regionally.  Dr Sutton is working with clinicians at facilities to update existing transfusion policies and better reflect these new ideas.    “The data is out there, and the time to act is now” she says.  “Having shared hospital transfusion criteria in our region as a readily available practice guide for all physicians is a big step in the right direction.  It should facilitate more appropriate blood utilization and transfusion data review.”

1.  Rohde JM, Kimcheff DE, Blumberg N et al.  Health Care-Associated Infection After Red Blood Cell Transfusion.  A Systematic Review and Meta-analysis.  JAMA 2014;311(13):  1317.

2.  SuttonBC, RobertsD, Wright M et al.  Reducing Platelet and Red Blood Cell Utilization in a 325 Bed Hospital.  2013 AABB National Meeting.  Poster AP1.

Local medical partnerships make targeted therapies a reality for local cancer patients

With an unprecedented level of community involvement, The Medical Foundation, Harper Cancer Research Institute (HCRI), Saint Joseph Regional Medical Center and Beacon Health Systems are collaborating to bring personalized medicine using the Sequenom MassARRAY technology to the Michiana area.

Through grants and allocation of funds from each facility, The Medical Foundation will be able to provide mutational profiling for new cases of certain cancers in the area. Approximately 650 patients who present at Saint Joseph Regional Medical Center in Mishawaka and Plymouth, and Beacon Health Systems including Memorial Hospital and Elkhart General Hospital, with new cases of metastatic melanoma, lung cancer or colon cancer over the next two years will take advantage of the latest technology available.

The MassArray analyzer is able to examine the DNA in a tumor by looking for 105 mutations in one reading. The 105 mutations have been identified by researchers who have examined whether certain drug treatments benefit various patients with these specific actionable mutations. This testing allows pathologists and oncologists to spare patients the extreme toxicity associated with treatment that may never kill their particular tumor.

“This hits the whole idea of patient centered care from many different ways and it’s my hope that this will truly help patients who need this data to get optimum care for their tumors,” said Medical Director of Molecular Pathology at The Medical Foundation, Bobbie Sutton, M.D.  “That’s the bottom line here, I’m hoping that this will help change people’s lives for the better and help them fight their disease,” she said.

For Medical Oncologist Dr. Robin Zon, the information provided by the MassARRAY analyzer allows her to use targeted therapies for patients. Before the arrival of the Sequenom MassArray instrument, patients were mostly treated with a standard drug therapy that may or may not attack the cancerous mutations in the patient. Having tests performed to pinpoint the mutations was very expensive and hard to obtain locally with some tests costing patients several thousands of dollars.

“From a patient perspective, what this means is that if we can discover that a particular patient’s cancer has the right signature to be treated for a particularly targeted therapy, as opposed to chemotherapy, where you don’t know if it is going to work or not, with targeted therapy there is an increased, but not 100% guarantee that the therapy we are offering based on this information is going to be useful,” said Zon.

Zon encourages patients who are eligible for this type of testing and other clinical trials to become involved if possible because these types of trials are often instrumental in helping with further research endeavors.

“It’s all very much a learning curve so I think we’ve made advances for some actionable targets for lung, melanoma and colon, which is why those are the three that are being targeted with this new technology,” said Zon.

Dr. Sutton and Dr. Robert Tomec, President of The Medical Foundation, in accordance with recommendations from The College of American Pathologists (CAP) determined that concentrating on actionable mutations in metastatic melanoma, adenocarcinoma of the lung and colon cancer would be most beneficial to the community.

According to Dr. M. Sharon Stack, who applied for the Walther Cancer Foundation Grant on behalf of the Harper Cancer Research Institute and The Medical Foundation, lung cancer is the leading cause of cancer deaths in Indiana claiming over 4,000 lives annually.  She also noted that colon cancer is the third most diagnosed cancer in the state.  Additionally, in a study released in 2012, cancer rates in Northern Indiana, particularly in St. Joseph County, were significantly higher than the state average. These are just a few of the reasons her staff would like to begin researching these three types of cancers in patients at our local hospitals.

The Medical Foundation has agreed to provide testing during this pilot program at cost and Beacon Health Systems and Saint Joseph Regional Medical Center have each contributed funds to offset costs so patients can receive this state-of-the-art technology free of charge. Currently, many insurance companies don’t reimburse charges for certain types of molecular testing.

“We agreed to participate in the personalized testing fund for patients who have that need because it fits in the mission of Saint Joseph Regional Medical Center.  Part of what is embedded in St. Joe’s legacy and who we are in the community is to care for the poor and the underserved and there’s a lot of changes in the healthcare system, many for the good, but at the same time, it’s very challenging when you’re uninsured or underinsured or there’s testing that’s available for patients who just don’t have the wherewithal to have the testing,” said Christopher Karam, Chief Operating Officer at St. Joseph Regional Medical Center.

Greg Losasso, President of Elkhart General Hospital which is a part of Beacon Health Systems, agrees with Karam that both organizations have support and care of their patients as their number one priority when venturing into this partnership with HCRI and The Medical Foundation.

“We’ve always been committed to doing research and partnering with The Medical Foundation and Notre Dame, it gives us the breadth within the community to do things locally and really try and bring our care to a higher level.  That’s part of our ongoing commitment and that’s why it was so easy for us to get involved in this project,” said Losasso.  “Through research we make improvements not just in our local communities, but around the country and the world,” he said.

As for the future of this type of testing or use of the Sequenom MassARRAY analyzer following the two year grant, the possibilities are endless according to Tomec, Sutton and Andy Bullock, Ph.D., M.B.A, Associate Director at the Harper Cancer Research Institute.

For the team at HCRI, each patient who benefits from the mutational profiling will have a personal profile built which researchers will then analyze to see if certain geographical, lifestyle or other correlations can be drawn between patients.

Also, The Medical Foundation will work closely with HCRI to analyze DNA from paraffin blocks that have been stored at the Foundation for several decades.  The paraffin blocks contain small cancerous tumors which may contain several samples from certain patients over time.  When the DNA is run on the analyzer, researchers will be able to examine mutation profile changes over time. Researchers are hoping to learn more about how treatment may have affected the mutations over time.

As for Sutton, she believes work may continue with tumors, but there is also the possibility of creating better testing for hemoglobin electrophoresis among other DNA based projects.

“I anticipate going forward, that this analyzer will still be the workhorse churning out data on a regular basis. Maybe not on tumors, but there are other options, other topics that I want to aim at just because I think it’s good medicine,” said Sutton.

Tomec believes there are numerous possibilities, as well.  “As technology changes I think there will still be a role for this MassARRAY technology not only in solid tumor testing but in other areas such as pharmacogenetics and tissue identification, so the value of the technology will be ongoing,” he said.

The collaboration and partnerships with the hospitals, HCRI and The Medical Foundation continues to grow because, “we can all unite by putting the community and our patients first, because we all have that as a priority, which is a great example of why we should be participating and working together,” said Karam.  “We all have that common goal, to take care of the people in the Michiana community,” he said.