A Cumulative Retrospective and Vision of the Role of the Cancer Committee for
I would like to share with you how our vision of cancer care has evolved over the last three years in light of the dramatic advances in diagnostic capabilities, genomics (personalized medicine), primary prevention and the promise of a continuum of care that precedes a diagnosis of cancer.
- At NewYork-Presbyterian/Lawrence Hospital, we have the first functioning Cancer Survivorship Program in the region outside of MSKCC. It is recognized as a ‘best practice’ by the Oncology Roundtable and is considered a model for community hospitals in the U.S.
- We have budgeted for a cancer ‘pre-habilitation’ program modeled after Julie Silver MD’s program at Harvard. This is rehabilitation that starts before treatment is initiated in order to minimize adverse outcomes in the future once a patient becomes a survivor.
- We have begun to inform and educate cancer survivors, their relatives and others in the community on issues such as healthy lifestyles, obesity, insulin resistance and to clarify the possible benefits of interventions such as metformin for prostate, breast and other cancer patients as reported in the media and literature. For instance, we have given lectures to the community regarding the pending and anxiously awaited results of the SUCCESS-C and MA.32 trials regarding lifestyle intervention and reduction of inflammatory markers in early breast cancer with metformin respectively.
- Transparency of evidence based information only helps our community to make sense of the barrage of information on the internet. For instance, there is no reason not to advocate lifestyle changes before a cancer diagnosis and, in addition, there may be extrapolations from MA.32 that might suggest that more primary prevention and post diagnosis trials should be explored with drugs like metformin (and possibly others) although this is still speculative but nonetheless tantalizing.
- We try to temper media news bytes with real science that the public can understand and attempt to elaborate on the tidal wave of information on the Internet and separate conjecture from level one evidence. Our survivorship meetings have helped to recruit family and relatives of cancer survivors who have expressed interest in cancer prevention.
- On that note, for the last seven years, we have aggressively and proactively been recruiting patients via our primary care physicians, breast imaging radiologists and breast surgeons who fit the criteria for breast cancer primary prevention with either Tamoxifen or Raloxifene. This was being done at our institution even before the recent USPTF recommendations.
- We have been actively working with our interventional radiologists and pathologists to coordinate tissue acquisition and marker analysis on lung cancer specimens. There has also been an attempt as part of a quality study to have MSI and MMR data added to colon cancer lymph node number and LVI so oncologists can personalize treatment for stage II colon cancer patients as per NCCN guidelines. We have also hired a geneticist who has been invaluable to our medical staff in educating them about screening patients in there practice for BRCA, Lynch and other testing.
- We have markedly improved our documentation protocols for NCCN treatment guidelines and AJCC staging for both our outpatients and in-house patients.
- Our Palliative Care program has been involved in two of our quality studies that include advanced lung cancer patients and how timely such services are ordered. This is based upon several randomized trials showing palliative care and chemotherapy vs. chemotherapy alone improves overall survival. The Palliative Care team has been an invaluable resource to our patients.
- And we have hired a Nurse Navigator who addresses the issue of coordination of care. This service is especially useful for our elderly patients who often depend upon a multitude of family and surrogate caregivers. This service has greatly facilitated the work up process and decreased the time to initiation of treatment.
- Our Physical Medicine, Pastoral Care, Dietary and Pharmacy departments have also been actively involved in our cancer committee.
We are truly a multidisciplinary team. Several years ago, I wrote an article for Cancer.Net that described for patients the definition and utility of tumor boards despite some recent criticism in JNCCN regarding their benefit.
There is a sense of great change that is happening in cancer care but not all for the good: overtreatment of patients with newer, more expensive interventions that may lead to marginal benefit, uneven access to care for certain patient populations, drug shortages, lack of coordinated care, how to deal with an aging population (an area of intense and active study for our institution) etc. We are trying to address these issues for our patients.
There are probably many more items that I have inadvertently omitted since we have been busy accommodating an increased number of outpatients. In response to this demand we are happy to announce that we have broken ground on a new Surgery and Oncology Pavilion at NewYork-Presbyterian/Lawrence that will house most of the multidisciplinary teams that report to the cancer committee. We are also applying for accreditation by the NAPBC for our breast program. Also our Breast Imaging Center has been recognized as a Center of Excellence under the guidance of Dr. Lynn Chinitz.
These are the best of times and the worst of times in health care today but we at Lawrence believe we are trailblazers and not followers for the community hospital cancer program.
Anthony F. Provenzano MD
Chairman of the Cancer Committee