At the Helm

Art Rich is a production manager who makes big events happen — big events like Broadway plays, concert tours, corporate conferences and even Nashville’s CMA Fest.

He has his eyes focused on the lighting, his ears attuned to the sound, and his scheduling of logistics perfectly organized for these events. He knows that the right talent, timing and expertise are crucial for success.

That’s why he sought a second opinion at Vanderbilt-Ingram Cancer Center in 2018. He had been dealing with a medical crisis and a delayed diagnosis. It had taken three biopsies and two months for him to be told he had inoperable pancreatic cancer.

“It was terrible,” Rich said. “Even though they said I might have cancer, there seemed to be no urgency.”

He came to Vanderbilt-Ingram after a friend told him about Kamran Idrees, MD, MSCI, MMHC, Ingram Associate Professor of Cancer Research and chief of the Division of Surgical Oncology and Endocrine Surgery, who specializes in treating complex cancers of the pancreas, liver and bile ducts that may involve major blood vessels and adjacent organs. Rich’s case was complex, but he was able to get the surgery he needed at Vanderbilt. However, he had to wait until the time was right while his pancreatic cancer was monitored as he received rounds of chemotherapy and radiation. Typically, in cases that are not complex, when the cancer has not spread beyond the pancreas to other organs, the treatment is more straightforward with surgery occurring first followed by chemotherapy and radiation.

“These complex surgeries are not usually performed at private hospitals,” said Idrees, who also serves as director of Pancreatic and Gastro-Intestinal Surgical Oncology. “They require highly specialized centers, high-volume pancreas centers, such as ours. These are cases that are deemed unresectable by some surgeons. That’s where the importance of a second opinion comes in.”

The Vanderbilt Pancreas Center offers a protocol that prioritizes time to treatment, second opinion sessions, a multidisciplinary clinic and a nurse navigator to personally assist patients. Vanderbilt has the only Pancreatic Cancer Center of Excellence as designated by The National Pancreas Foundation in Tennessee, Alabama, Mississippi or Arkansas.

Amy Hayes, BSN, RN, OCN, the nurse navigator, helped Rich get an appointment with Idrees.

“It’s completely understandable for patients and their families to feel overwhelmed with a cancer diagnosis along with trying to navigate a complex health care system,” Hayes said. “I am here to help lessen these burdens so the patient and their loved ones can focus on healing and to ensure there are no unnecessary delays in their care.”

Even though Idrees advised Rich that he could not perform a surgery at the beginning of his treatment, he didn’t close the door on the possibility. The Vanderbilt Pancreas Center offers an aggressive treatment approach of neoadjuvant chemotherapy followed by resection for complex cases when the pancreatic cancer has spread and involves blood vessels that connect to vital organs. Idrees initially told Rich that although his tumor appeared to be unresectable because of major blood vessel involvement, he would refer him to Dana Cardin, MD, MSCI,

associate professor of Medicine in the Division of Hematology and Oncology, for chemotherapy with the hope that the tumor would shrink away from these blood vessels.

Idrees works closely with the multidisciplinary pancreas team at the Vanderbilt Pancreas Center to monitor a tumor’s response to chemotherapy, checking to see if and when it shrinks enough to proceed with surgery.

“We are doing surgeries that are not being done at other major hospital systems in Nashville or in neighboring states,” Idrees said. “We perform them in conjunction with other major specialties. We have the luxury of vascular surgeons and organ transplant surgeons available. We can resect major blood vessels and reconstruct blood vessels if they are deemed involved with a tumor.”

Cardin treated Rich’s cancer with rounds of FOLFIRINOX, an aggressive combination of multiple chemotherapies, for six months then referred him for radiation therapy. He then went on a maintenance program with the chemotherapy capecitabine, taking the drug orally for two weeks, then one week off.

“During my treatment while I was on chemotherapy, I was the production manager for the 2019 CMA Fest,” he said. “I had a six-month contract, and I put all that together while I was on chemotherapy. What I do is oversee the logistics of live music. I managed the lighting, sound, video, labor, staging, trucking, busing, the crews. I would receive my chemotherapy or radiation then go to Nissan stadium and work the rest of the day.”

Although he tolerated the treatments, it seemed for months as though there would not be a strong enough response for him to undergo surgery to have the cancer removed. He never gave up hope and would ask if his prospects had changed.

About a year and a half after he started the chemotherapy, Rich had another appointment with Idrees.

“Dr. Idrees opened my file and compared the latest scans — before and after chemotherapy — and something in there caught his eye,” Rich said. “I had been on this journey for over two years at this point. Dr. Idrees comes bounding in the examination room, and the first thing I notice is that his body language is radically different than in our previous meetings.”

The surgeon sat down with Rich and his wife, Lisa, and explained how the surgery would be performed. Idrees detailed the steps and informed him that a team would be involved.

The surgery occurred on Oct. 30, 2020.

“I was on the table for 14 hours,” Rich said. “One of the hurdles was to cut the artery that leads to the spleen. Dr. Idrees and his team took out all of the pancreas, the spleen, the gallbladder, 18 lymph nodes, and part of the small intestines and part of the stomach.”

Tests since the surgery indicate that Rich is cancer free. He relishes time spent with his wife, son and daughter. He enjoys spending time on his boat on Percy Priest Lake and going to church. He is thankful for answered prayers.