1. C
amp Bluebird—is it a special place
or a special program or is it just
that special feeling you have after
you’ve been there? Can you explain Camp
Bluebird to others, or do you just have to
experience it firsthand? Is it like the camps
that we remember as children, rustic and
full of splinters, or is it butterflies and fire-
flies? It is all of these things and more.
Camp Bluebird is a safe place where
you can share your hopes, fears, and
experiences with others who understand
what you are going through, because they
have actually walked in your shoes. It is a
community of understanding, filled with
people with whom you have an imme-
diate bond. At Camp Bluebird, you feel
I
n 2013 it is estimated that there will be
228,190 new cases and 159,480 deaths
due to lung cancer in the United
States,1
making it the leading cause of
cancer-related death. In fact, it causes
more deaths than colon, breast, and pros-
tate cancer combined.2
Two main lung
cancer histologic subtypes exist: small
cell and non-small cell, with each having
different clinicopathologic characteris-
tics. The most common type is non-small
cell (7 of every 8 people),3
which includes
squamous cell carcinoma, adenocarcino-
ma, and large cell carcinoma.
Most often lung cancer occurs when
people breathe in dangerous, toxic sub-
stances. It is believed that smoking causes
lung cancer by damaging the cells lining
the lungs; as such, cigarette smoking is the
©2013 Green Hill Healthcare Communications, LLC
GENETIC COUNSELING
Inherited Susceptibility to Lung
Cancer: What Do We Know?
Cristi Radford, MS, CGC
Ambry Genetics
Continued on page 12
Continued on page 18
T
he Moffitt Cancer Center in Tampa, Florida, is 1 of 41 cancer
centers in the United States to receive the National Cancer
Institute’s designation as a comprehensive cancer center, and
it is the only such center based in the state of Florida. As a center of
excellence, Moffitt takes care of patients’ needs starting with diag-
nosis through cancer treatment on to survivorship. Moffitt is also an
active research center, covering basic science, prevention, and clin-
ical research with the goal of translating discoveries into improved
patient care. Moffitt is committed to Total Cancer Care—a personal-
ized course of treatment that provides individualized therapies based
on a patient’s unique genetic fingerprint.
The Oncology Nurse-APN/PA spoke with Elizabeth (Beth) Finley,
RN, OCN, about her role at the Moffitt Cancer Center, where she
works exclusively with patients with multiple myeloma.
CANCER CENTER PROFILE
Members of the multiple myeloma team at the Moffitt Cancer Center (left to right):
Christine Simonelli, RN, BSN, OCN; Kenneth Shain, MD, PhD; Beth Finley, RN,
OCN; Rachid Baz, MD; and Sheri Lemanski, RN, BSN, OCN.
Moffitt Cancer Center
Providing Care for Patients With Multiple Myeloma
THE WHOLE PATIENT
Camp Bluebird: A
Survivorship Program
for Life
Leslie Verner, RN, BSN, OCN, CCRP, CBCN
Cancer Outreach Coordinator, Mission Hospital SECU
Cancer Center, Asheville, North Carolina
NOVEMBER 2013 www.TheOncologyNurse.com VOL 6, NO 10
NOTEWORTHY NUMBERS. . . . . . . . . 2
Breast Cancer
BREAST CANCER
Greater Attention to Cardiovascular
Risk Needed for Breast Cancer
Survivors. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Paroxetine Does Not Reduce
Tamoxifen’s Effectiveness in
Breast Cancer Survivors. . . . . . . . . . 21
SIDE EFFECTS MANAGEMENT
Raising Awareness of Cancer
Anorexia-Cachexia Syndrome in
Patients With Lung Cancer. . . . . . . . 16
Update on Managing
Dyspnea. . . . . . . . . . . . . . . . . . . . . . . . . . 17
LUNG CANCER. . . . . . . . . . . . . . . . . . . 22
Paclitaxel in Lung Cancer
I N S I D E
N
ovember is National Lung
Cancer Awareness Month. It
started in 1995 as Lung Cancer
Awareness Day and expanded as the lung
cancer community grew and awareness
of the disease increased. In this issue, we
explore some of the lung cancer–related
highlights from the European Cancer
Congress (ESMO/ECCO/ESTRO),
held September 27-October 1, 2013, in
Amsterdam, the Netherlands.
Continued on page 6
NEWS BRIEFS
Lung Cancer in the News
Alice Goodman
Continued on page 17

2. www.TheOncologyNurse.com18 NOVEMBER 2013 I VOL 6, NO 10
that you have been given permission
to enjoy life again and not let cancer
consume your thoughts. It is a place
where tears can flow freely and laughter
bubbles up at any moment—the kind
of laughter that you haven’t let yourself
experience in a long time, like every-
thing is going to be alright—the kind
of laughter that gives you hope again.
That is part of what Camp Bluebird is
all about, but it is also so much more.
First of all, simply put, Camp
Bluebird is a 2-night, 3-day retreat for
adult cancer survivors, held each spring
and fall in the beautiful mountains
of North Carolina. It is sponsored by
Mission Hospital in Asheville and the
AT&T Telephone Pioneers, the vol-
unteer organization of our local tele-
phone company. Anyone 18 years or
older with a past or current diagnosis of
cancer may attend. This year our Camp
Bluebird is joyfully celebrating its 20th
anniversary.
Camp Bluebird came to be in 1985,
when a cancer survivor in Birmingham,
Alabama, decided to start a retreat for
adult cancer survivors. He approached
the Foundation at St Vincent’s
Hospital, and with help from their
local Telephone Pioneers, America’s
first adult cancer camp was born. It
was named after the bluebird, which is
known as the “symbol of hope.” This
first 3-day retreat was so well received
by cancer survivors in the area that
St Vincent’s Hospital decided to share
the idea with other hospital systems
in the Southeast. Franchises were sold,
using the Camp Bluebird name, and 36
cancer retreats were started in various
parts of the country. Unfortunately, as
the years went by, some of these retreats
were discontinued due to lack of fund-
ing, but others continued to grow and
prosper. Now, 28 years later, the first
Camp Bluebird from St Vincent’s
Hospital is still going strong. It is
offered each fall at Camp Sumatanga
near Birmingham. Jeffrey Scott Powell,
Administrative Director of Development
for St Vincent’s Hospital Foundation,
estimates that there are at least 23 of the
original 36 Camp Bluebirds still in exis-
tence, extending from Florida to North
Carolina to Michigan to Texas.
Our Camp Bluebird was started in
1993, when an oncology nurse from
Mission Hospital in Asheville, North
Carolina, and a representative from
BellSouth, our local telephone company
at the time, traveled to Birmingham to
buy a Camp Bluebird franchise. We have
been extremely fortunate with funding
since our inception 20 years ago. Our
Mission Healthcare Foundation has
always supported Camp Bluebird finan-
cially when our operating budget was
running low. Although registration fees
cover some of the cost for each camp,
both private and corporate donations are
always greatly appreciated. For 10 of the
last 20 years, our local American Cancer
Society has donated $10,000 per year,
for a total gift of $100,000. Our ultimate
goal is for Camp Bluebird to one day
be financially self-sustaining, with all
future camps paid for by interest from an
endowment. This would be an incredible
gift for the cancer survivors of western
North Carolina.
We have always held our retreats
at the Bonclarken Conference Center
in historic Flat Rock, situated in
the beautiful mountains of North
Carolina about a 40-minute drive from
Mission Hospital. Accommodations
are very comfortable, each room hav-
ing 2 beds and a private bathroom. The
Bonclarken staff have always made us
feel welcome, and they are proud to
have hosted Camp Bluebird at their
facility for these last 20 years.
Mission Hospital has encouraged
their oncology nurses to serve as coun-
selors at Camp Bluebird, as have private
oncology offices. As an oncology nurse,
I personally became involved with
Camp Bluebird in 1994 when I was
asked to serve as a counselor at the fall
camp. Then a year later, the “director’s
baton” was passed over to me. Being
the director of Camp Bluebird has truly
been the most challenging and also the
most rewarding part of my career as an
oncology nurse. It has always been my
desire to make the cancer journey as
easy as possible for my patients. Camp
Bluebird is a special program that can
benefit survivors at any point in their
cancer journey: newly diagnosed, going
through treatment, at the end of their
treatment and unsure of what to do next,
dealing with a recurrence, or in the final
stages of their disease. Camp Bluebird
has something to offer EVERY survivor
at ANY time.
At each of our 3-day retreats, we have
50 to 60 adult cancer survivors (about
half returning campers and half first-tim-
ers) paired with 30 to 35 counselors,
comprising a wonderful combination of
oncology nurses from either the hospi-
tal setting or private oncology offices,
plus social workers, physical therapists,
chaplains, and the Telephone Pioneer
volunteers. It always amazes me to watch
the return campers make the first-time
campers feel immediately at home. Each
counselor’s job is to make his or her 2
campers feel special and pampered while
at Camp Bluebird, by sharing meals with
them, participating in free-time activities
together, and keeping an eye on them to
be sure they are feeling well and are not
in need of medical attention. At each
camp, in addition to the 6 to 8 oncology
nurse counselors, there is also a “dedicat-
ed” camp nurse whose role is to ensure
that all of the campers’ medical needs are
met. We also have a “dedicated” camp
chaplain available for spiritual support.
But by far, the biggest source of support at
camp is the emotional support the cancer
survivors give to each other, and it is truly
magical to see how each retreat takes on
its own personality because of the mix of
people that attend each camp. To watch
the first-time campers transform from
scared little “first graders” into confident
“seniors” by the third day of camp is like
watching a miracle unfold in front of your
very eyes.
Through the years, I have had many
campers tell me that Camp Bluebird has
changed their life. Through the tears
and the laughter they share with other
survivors at camp and with their counsel-
ors, they reach a point where they don’t
fear the future quite so much. They may
still fear recurrence of their cancer, but
through conversations with other camp-
ers and advice from trained facilitators in
the small groups they attend, our campers
learn coping skills that allow them to
enjoy each day rather than dread what
might happen.
With 2 camps offered each year, it is
always a challenge to come up with activ-
ities that are fresh and new. Campers can
choose from a variety of activities offered
during free time between 1:00 and 5:30
pm on the first 2 days of camp. They are
always encouraged to pick and choose
those that interest them most, to avoid
fatigue from overscheduling themselves.
THE WHOLE PATIENT
The Camp Bluebird quilt.
Camp Bluebird: A Survivorship Program for Life Continued from cover
A costume party at Camp Bluebird.

3. NOVEMBER 2013 I VOL 6, NO 10 19www.TheOncologyNurse.com
THE WHOLE PATIENT
Some take this advice, and others want
to participate in everything! Many of the
activities allow both the campers and
their counselors to participate together.
Other activities, such as the Healing
Touch Reiki Therapy, are provided spe-
cifically for the campers themselves.
We also offer more serious, contem-
plative activities, such as the Service
of Remembrance, which is held on
the second morning of camp in a very
special memorial garden, outside under
the trees. At this spiritual service, we
remember past campers who are no
longer with us, by symbolically put-
ting a scoop of dirt into the base of a
potted tree that will be planted on the
Bonclarken property in their memory.
The camp chaplain leads this service,
and it is always very emotional.
Immediately following this memo-
rial service, campers are encouraged
to attend small group sessions, where
they can choose from several topics
that may be pertinent to their situ-
ations. Each group is led by a well-
trained facilitator, whether it be an
oncology nurse, social worker, or the
camp chaplain. Some of the topics
include Fear of Recurrence, Helping
Your Family Deal With Your Cancer,
Spirituality Issues, Healthy Eating for
the Cancer Survivor, Dealing With
Chemotherapy and/or Radiation Side
Effects, and Survivorship Issues. We
offer these small group sessions twice
during each camp.
Mealtime is always very special at
Camp Bluebird, not only because the
food is delicious, but also because it is a
time to relax with new and old friends
and reflect over the day. Many friend-
ships have been made and strengthened
around the dining room tables at Camp
Bluebird. We always take a full hour
for each meal, because it is such an
important time for sharing. After din-
ner, we all let our hair down and our
free spirits come out to play, with live
musical entertainment. In recent years,
I have seen a lot of dancing in the aisles,
and that is always encouraged! When
we have a live band combined with a
costume party, everyone is encouraged
to dress up, but it is not required. Each
party has a theme, such as a Hawaiian
Luau, a ’50s Sock Hop, a ’60s Hippie
Party, a Country Western Party, an
Olympics Party, or a Come Dressed
as Your Favorite Movie Star/Sports
Personality Party. I mail a letter to each
camper about 6 to 8 weeks before the
next camp to let them know the theme
of the costume party so they have plen-
ty of time to put together a costume if
they want to dress up. Prizes are often
awarded for the most creative costumes.
On the last day of each camp, after
the counselors help the campers take
their suitcases to the cars, we offer either
a small group or a panel discussion. At
our spring camp in May, we had a panel
of experts discussing pertinent survi-
vorship issues such as long-term dis-
ability, Medicare/Medicaid, healthcare
power of attorney, living wills, and hos-
pice/palliative care. Then for the final
lunch, campers are encouraged to invite
friends and/or family to join us. At the
closing ceremony, we show a slideshow
of photos taken throughout the last
3 days. Seeing the expressions on the
faces of the campers—enjoying them-
selves and feeling free to just be who
they are, accepted by all, wig or not,
hair or no hair—is exhilarating. The
pictures in that final slideshow say it
all: Camp Bluebird is a place where you
can just relax, throw your troubles away,
and go home with a renewed zest for
life. The immediate friendships made
at Camp Bluebird may be some of the
most meaningful friendships you have
ever had. While we nurses can express
our compassion and educate you about
your cancer and try to calm your fears,
we can’t know deep down in our souls
how you are truly feeling, like another
cancer survivor can. As the camp
chaplain says the closing prayer, some
of the campers seem afraid to leave this
safe place, thinking they might lose the
peace and serenity they have felt here.
The good news is that many campers
have told me that this peace has stayed
with them long after leaving Camp
Bluebird and that their newly acquired
coping skills have helped sustain them
during times of worry and stress.
These “graduates” of Camp Bluebird
are always invited to attend again in
the future. However, since survivors are
living longer due to early detection and
better treatment options, about 10 years
ago I had to make the difficult decision
to let campers return to only one camp
per year. Every January, past campers
receive a questionnaire, asking if they
would like to attend the spring or fall
camp that year. I always give priority
to first-time campers and to those
who are dealing with a recurrence of
disease. If a return camper has been
to more than 5 previous camps, I
automatically put them on a waiting
list until I know we’ll have a spot
for them. Fortunately, a camper has
NEVER been turned away from our
Camp Bluebird because of inability to
pay. For many years, the registration
fee for first-time campers has stayed
at $40, but if that is a problem, we
ALWAYS have partial or full schol-
arships available to cover the registra-
tion fee. The fee for return campers
has been set at $75 for the last 5 years
or so, and if that is a problem, scholar-
ships are available, no questions asked.
In closing, I want to tell the story
of a woman with breast cancer who
attended Camp Bluebird for many years
back in the mid-1990s. Unfortunately,
her disease progressed, and each time
her husband brought her to camp, she
appeared more frail. The final camp she
attended, she stayed in a wheelchair
most of the time because of weakness
and bone pain. However, during the
costume party while the band was play-
ing, she got up out of that wheelchair
and danced for a couple of minutes.
You should have seen the look of joy
on her face. The rest of us were smiling
too, through our tears. And when her
husband came to pick her up on the last
day of camp, she had the energy to walk
out to him without assistance. We lost
her to breast cancer a few months later,
but we were all truly inspired by the
incredible courage she displayed. Now
her husband is a survivor too, and he
comes to camp and always talks about
his precious wife and how she loved
Camp Bluebird.
We will never forget these special
patients who pass through our lives and
find a permanent place in our hearts. As
oncology nurses, we do all that we can
to make their cancer journey as easy as
possible, and in return they teach us so
much more than we could ever teach
them. They have all figured out the
secret of life and what is truly impor-
tant, living in the moment and being
with the ones you love. Camp Bluebird
is like that…living in the moment and
being with the ones you love. It is so
much more than a place or a program…
it is a feeling that you carry with you
after you leave. It is permission to enjoy
the rest of your life. Camp Bluebird is
hope for your future, no matter how
short or long that future might be. l
For more information about starting a survi-
vorship program like Camp Bluebird, please
contact Leslie Verner at 828-213-4656 or
leslie.verner@msj.org.
“Camp Bluebird allows us to try new things, to
stretch ourselves. I remember at my first camp, I
reluctantly signed up for Reiki Therapy and didn’t
know how this could possibly make me feel better.
Well, one hour later, I staggered, completely in a
state of bliss, from the Reiki room and was a firm
believer in this healing touch therapy modality.”
Carolyn Comeau, a breast cancer survivor who has
attended Camp Bluebird several times, speaks of her
first experience at Camp Bluebird
A fishing party at Camp Bluebird.
Making a birdhouse at Camp Bluebird.