The secret of the care of the patient is in caring for the patient.

Transcription

1 An exciting NEW ERA in personalized medicine Mercy Oncology Annual Report 2017

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3 Embrace Change Welcome to the second edition of the Mercy Oncology Program s Annual Report has brought a number of exciting changes to our program. Diane Stoller, MD, breast surgeon, and Jeff Georgia, MD, interventional radiologist, joined our team. New 3-D mammography technology for breast cancer screening is now available to patients, and we are collaborating with The Jackson Laboratory on a ground-breaking new study which allows us to offer expanded genetic analysis of solid tumors. These changes are not only welcome, but necessary as we remain committed to keeping pace with new developments in cancer care year after year. This issue of the Annual Report will highlight some of the recent changes and new faces in our ever-evolving cancer program. The secret of the care of the patient is in caring for the patient. - Dr. Francis Peabody As we embrace change and continue to move forward, however, we are constantly reminded of our mission, To provide clinically excellent, compassionate health care for all. A state-of-theart diagnostic test or a brand-new chemotherapy drug alone doesn t have the same effect as a kind word or a healing touch. To treat the entire patient, we will continue to incorporate both types of medicine into our truly comprehensive cancer care program. As Dr. Francis Peabody said, The secret of the care of the patient is in caring for the patient. We hope you ll join us in taking a moment to celebrate the successes of 2017, as we look forward to the new year with renewed enthusiasm for discovering what is possible for our program, and our patients. 03 3

4 Clinicians in Mercy s cancer program care for patients with a variety of diagnoses, including common (breast, lung, colon) and less common malignancies 4

5 Comprehensive Cancer Care Mercy s comprehensive cancer care program offers complete care for most adult cancers, including both solid tumors and hematologic malignancies like leukemia and lymphoma. Mercy physicians are available for consultation in the following specialties: medical oncology, surgical oncology, breast surgery, and head & neck surgery. Additional services include: Breast imaging Nutritional assessment and management Clinical trials Ostomy and wound care Colonoscopy and endoscopy Palliative care Diagnostic imaging including CT, MRI, and PET-CT Patient navigation Financial counseling Referral to collaborating physicians in radiation oncology, thoracic surgery, and urology Genetic testing Infusion therapy including chemotherapy and biotherapy Rehabilitative services: Physical and occupational therapy, speech therapy, lymphedema clinic Interventional radiology Social work services other 35 colon 7 bronch lung 9 hema 5 breast 28 prostate 6 Survivorship care bladder 10 Types of cancers cared for by Mercy physicians in 2016: Colon 7% Bronchus & Lung 9% Other 35% Hematopoietic & Reticuloendo System 5% Bladder 10% Prostate Gland 6% Breast 28% 05 5

6 Nationally Accredited Care, Close to Home In April 2017, Breast Care Specialists of Maine (BCSOM) at Mercy Hospital received its second full three-year accreditation from the National Accreditation Program for Breast Centers (NAPBC). To become accredited, a center must demonstrate compliance with 28 quality standards. In addition to providing the NAPBC with documentation of compliance annually, the center must also pass an on-site inspection initially and every 3 years. NAPBC standards include: Center Leadership & Administration Multidisciplinary Clinical Patient Management Radiology Pathology Genetics Clinical Trials Professional Education Quality Improvement 6 Mercy s multidisciplinary team for breast cancer care includes surgeons, medical and radiation oncologists, radiology, pathology, genetic counseling services, specialized nurses, social work, nutrition, physical and occupational therapy, and lymphedema specialists.

7 NAPBC standards (cont.) Many departments within and outside of Mercy collaborate in this effort. One of the standards requires a Multidisciplinary Breast Cancer Conference in which patient cases are discussed with all disciplines present, including surgery, pathology, radiology, medical oncology, radiation oncology, and support services. This conference convenes every two weeks under the direction of Mercy s breast surgeons, Suzanne Hoekstra, MD and Diane Stoller, MD. Through this mechanism, we can assure patients receive quality care based on current standards. Under the guidance of Dr. Hoekstra, BCSOM obtained its initial certification in 2011 and was re-certified in both 2014 and It passed each inspection with 100 percent compliance with all standards. Mercy Breast Cancer Program 2016 Stage at Diagnosis mercy national Mercy National Patients with both early and late stage breast cancer receive high-quality care based on current national standards with Mercy s dedicated team Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 stages 7

8 Diane Stoller, MD FACS Experienced Breast Surgeon Joins Mercy Team Diane Stoller, MD, joined Breast Care Specialists of Maine in October Originally from Chadron, Nebraska, she received her Doctor of Medicine degree from the University of Missouri, Kansas City. Before relocating to Maine, she practiced for 25 years at the NAPBC-accredited Piper Breast Center in Minneapolis, Minnesota. As a board-certified breast surgeon and an experienced participant in several of the quality initiatives in place at BCSOM, Dr. Stoller brings a wealth of knowledge, experience, and enthusiasm to the practice. In her free time, she enjoys being outdoors and training for marathons and triathlons, as well as learning to sail. Knitting, quilting, cooking, and baking keep her busy during the winter months. I have a passion for meeting breast cancer patients wherever they are and giving them personal care. I hope to meet their medical and emotional needs while they make their journey through breast cancer. - Diane K. Stoller, MD FACS 8

9 Lung Cancer Screening Program The Mercy Hospital Lung Cancer Screening Program is a multispecialty effort to enhance early detection rates and to reduce the high mortality associated with lung cancer in Southern Maine. The program integrates Primary Care, Diagnostic and Interventional Radiology, Pulmonary, and Cardio Thoracic specialty physicians, as well as physician assistants, nurses and technologists. People who fill the National Lung Screening criteria undergo a shared decision-making session prior to being enrolled in the program. To fit the criteria a person must be: 55 years and older Have a 30-pack year history or greater of smoking (1 Pack per day per year for 30 years or equivalent) Asymptomatic Most patients have no actionable findings on their exam and are enrolled in an annual screening program. Lynn Augustine, CT Tech Once enrolled, patients are screened with a low-dose, non-contrast chest CT scan. Patients are offered the option to review their results immediately after their appointment or with their primary care physician. A smoking cessation session is provided at the time of the CT appointment. Most patients have no actionable findings on their exam and are enrolled in an annual screening program. Patients who require either further imaging with short term follow-up chest CT or PET/CT exam, or consultation with Pulmonary Medicine, Interventional Radiology, or Cardio-Thoracic surgery have their appointments made before they depart the Radiology Department. The program has screened between 220 and 350 patients annually since its inception in We enter all cases into the American College of Radiology Lung Cancer Registry which is reviewed semi-annually. 9

10 I tend to go slower, and try to be incredibly sensitive with the oncology patients. It s a much gentler approach that s needed. You need to listen a lot more. - Julie West, Nurse Practitioner Julie West, Nurse Practitioner Palliative Care 10

11 Palliative care services are a critical component of Mercy s Multidisciplinary Cancer Program. Nurse practitioner Julie West, who joined the Mercy team in 2016, provides palliative care consultation and follow-up in both the inpatient and outpatient settings. Originally from Massachusetts, West completed her nurse practitioner training at Boston College in 2013 and is certified in palliative care. Palliative care is an approach that prioritizes improving quality of life for patients and families facing problems associated with life-threatening illness. West works closely with patients, families, and Mercy oncologists to integrate palliative care into each patient s treatment plan. Palliative care balances treatment goals and symptom management, and focuses on concerns expressed by the patient. It s a team approach to try to maximize the quality of life for our patients. Symptoms prompting palliative care consultation include pain, shortness of breath, nausea, fatigue, and weight loss. While these symptoms are common to many types of patients, West has found that oncology patients sometimes require a different approach: I tend to go slower, and try to be incredibly sensitive with the oncology patients. It s a much gentler approach that s needed. You need to listen a lot more. West spends her time consulting on symptom management; coordinating with oncologists, visiting nurses, and other health professionals, and counseling patients and families. Facilitating family meetings is a particularly important part of her work. Nobody goes through cancer alone, says West. Patients and families don t know how to talk about these things, so it s helpful having somebody there to moderate the discussion so people can voice their vulnerabilities, their fears. West describes her specialty as a philosophy of care, and one that she enjoys being a part of: I can t imagine doing anything else. It s really just a calling for me. 11

12 An Exciting New Era Medical oncology has entered into an exciting new era of personalized medicine in which many patients receive targeted therapies based on the specific molecular profile found in their tumor tissue. Unlike traditional chemotherapy, which can damage a variety of tissues leading to toxic side effects, targeted therapy is designed to attack tumor cells specifically. In properly selected patients, these newer medications can be used to create an individualized treatment plan, providing more effective treatment with fewer side effects. For example, approximately 20 percent of patients with the most common form of lung cancer harbor mutations that the newer drugs can target. These drugs can be given in pill form and are more effective and less toxic than traditional chemotherapy. Recent advances in DNA sequencing allow medical oncologists to identify similar biomarkers in a wide variety of tumors, expanding the group of patients who can benefit from these targeted medications. Dr. Ronald S. Guibord, MD Chief of the Department of Pathology and Laboratory Medicine at Mercy Hospital 12

13 Mercy Hospital is participating in the Maine Cancer Genomics Initiative, which is a cutting edge research protocol that uses next-generation DNA sequencing performed at The Jackson Laboratory to identify possible mutations in over 250 genes commonly identified in cancers. If mutations are identified, oncologists at Mercy Hospital will collaborate with scientific consultants at The Jackson Laboratory to design personalized treatment plans that might include commercially available targeted therapies or participation on a clinical trial evaluating the newest agents. This innovative strategy will help patients at Mercy Hospital receive precision treatment that takes advantage of recent scientific advances while maintaining a good quality of life. About 5-10 percent of all cancers are hereditary, and the risk of cancer can be passed from one generation to the next. 13

14 Genetic testing can help individuals make health care decisions based on their actual risks. Dana Greer, Genetic Counselor Mercy Oncology-Hematology Center 14

15 Understanding your family history is an important tool in the fight against cancer, especially in the field of cancer prevention. Recent advances have identified a number of genes associated with inherited susceptibility to cancer and have provided a means for identifying individuals and families with an increased risk of cancer. About 5-10 percent of all cancers are hereditary, and the risk of cancer can be passed from one generation to the next. Two of the most welldocumented inherited cancer syndromes are hereditary breast and ovarian cancer, and hereditary non-polyposis colorectal cancer (HNPCC). Both of these conditions can be identified by a blood test, which is just one step in the process of hereditary risk screening and counseling. Screening Services Hereditary risk screening services at Mercy are provided through the oncology department and supervised by Anna Niegowska, MD. Mercy s hereditary cancer risk assessment model consists of: Collecting and interpreting a detailed medical and threegenerational family history Calculating a personalized risk assessment and providing individualized counseling based on risks Discussing options for prevention, surveillance, and medical management Coordinating and interpreting genetic testing when indicated Developing a management plan in collaboration with the patient and the primary or specialty physician(s). Knowing whether or not a hereditary predisposition exists in a family allows those both affected and unaffected by cancer, and their physicians, to make personalized decisions related to cancer prevention and treatment. 15

16 Mercy Hospital Cancer Program Mercy All About Women 195 Fore River Parkway, Suite 310 Portland, ME P Mercy Breast Care Specialists of Maine 195 Fore River Parkway, Suite 250 Portland, ME P Mercy Oncology-Hematology Center 195 Fore River Parkway, Suite 360 Portland, ME P Mercy Portland Surgical Associates 195 Fore River Parkway, Suite 420 Portland, ME P Mercy ENT Associates Ear, Nose and Throat Specialists 43 Baxter Boulevard Portland, ME P Mercy Gastroenterology at Casco Bay 25 Long Creek Drive South Portland, ME P Mercy Pulmonary and Critical Care 144 State Street Portland, ME P Fore River Urology 21 Donald B. Dean Drive South Portland, ME P mercyhospital.org/cancer