MARCH IS WOMEN’S HISTORY Month, and women are shaping the future of healthcare, as they make approximately 80 percent of healthcare decisions. Hospitals and physicians are pursuing state-of-the-art medical care for breast cancer, maternity care and other conditions that affect so many women.
This year’s Chief Medical Officers Roundtable, which explores the latest advances in patient care for women, features AtlantiCare, a Member of Geisinger; Atlantic Health System; CentraState Medical Center; Englewood Hospital and Medical Center; Hackensack Meridian Health; Holy Name Medical Center; Rutgers Cancer Institute of New Jersey; RWJBarnabas Health; Trinitas Comprehensive Cancer Center; and Valley–Mount Sinai Comprehensive Cancer Care.
AtlantiCare, A Member of Geisinger
By Marilouise Venditti, M.D., VP and Chief Medical Officer
Advances in breast cancer screening and management include enhanced imaging techniques, refined surgical techniques, targeted therapy, immunotherapy and new radiation treatment. Through high dose rate brachytherapy, we shorten the length of time breast cancer patients, who qualify, get radiation therapy from six-and-a-half weeks and more than 30 treatments, to five, twice-a-day treatment days, saving time while sparing healthy tissue and organs. Another example is that we place a biodegradable cage within the breast tumor bed at the time of resection for patients who qualify. This more clearly defines the portion of the tumor we’ve removed. We better target radiation and decrease radiation exposure to healthy tissue and organs. The body absorbs the biodegradable material. As the industry learns more about the pathophysiology of breast cancer, it will develop more targeted treatments with fewer side effects. A critical part of breast cancer care is our precision medicine approach of accounting for individual variability in genes, environments and lifestyles of patients. Research, including clinical trials, will continue to play a key role in how we evolve cancer care.
Atlantic Health System
By Jan Schwarz-Miller, M.D., Chief Medical Officer and Chief Academic Officer
Combining the most advanced technology with an array of patient support services has made Atlantic Health System a leader in breast cancer treatment. The most recent example is the TrueBeam™ Radiotherapy System. It’s a large jump forward in terms of surface guided radiation therapy, and it gives us the ability to provide faster, more targeted radiation treatments for all types of cancer patients. It’s the very latest technology, and, in the case of left breast cancers, it also helps minimize radiation dosage to critical organs such as the heart and the lungs. Previous machines also did not consistently account for contour of the breast, which could change slightly according to the position of the patient, during treatment. With the new surface image guided radiation technique that’s part of TrueBeam™, we’re able to have a completely accurate setup and get more precise radiation doses to the parts of the breast being targeted. When it comes to patient care, Atlantic Health System has always been on the forefront of using new technology as part of the most advanced treatments in our field.
CentraState Medical Center
By Edward Soffen, M.D., Medical Director, the Karen Olbis Radiation Oncology Dept., Board-Certified Radiation Oncologist
Going through breast cancer treatment is emotionally and physically difficult for women. It’s also a major disruption to a woman’s everyday life. In the case of radiation therapy, women have traditionally received daily treatments for at least six weeks. At the Statesir Cancer Center at CentraState Medical Center, we offer an accelerated, updated approach to radiation therapy following lumpectomy surgery for women diagnosed with early stage breast cancers. This new approach, called hypofractionation, allows women to complete radiation therapy in nearly half the amount of time. Hypofractionation is as effective as conventional radiation protocols in preventing recurrence of breast cancer. It has also been shown to be equal in limiting potential cosmetic and other side effects of radiation. Hypofractionation delivers the same biologically equivalent dose of radiation to the breast as traditional therapy, just in fewer days, with more radiation each day. That allows us to shorten the treatment course to roughly four weeks of daily treatments. Hypofractionation is appropriate for women who have lymph node-negative breast cancer— early stage cancers that have not spread beyond the breast; have had lumpectomy surgery, with or without chemotherapy; and do not have other medical conditions that may put them at higher risk for side effects from a higher radiation dose.
Englewood Hospital and Medical Center
By Michael T. Harris, M.D., Senior VP, Chief Medical Officer
Cancer affects every patient differently, so it’s crucial that we take an individualized approach to each patient we treat. Starting with screening and diagnosis, we read results in real time, with same-day physician consult, which minimizes anxiety and reduces callbacks for diagnostic mammograms. We’ve also begun using new targeted therapies in place of chemotherapies. These include drugs that overcome hormone resistance, and drugs that induce, enhance or suppress an immune response. As a result, there are more pharmacologic options for cancer treatment and prevention, with fewer side effects. Another improvement in cancer treatment involves a radiation therapy technique called deep-inspiration breath hold (DIBH), which maximizes the benefit of radiation therapy, and lessens the risks of whole-breast radiation therapy.
As a patient takes a deep breath, a system of digital projectors and cameras detects skin contours, determining proper orientation and inspiration before each treatment dose, minimizing the heart and lung exposure within the treatment area. In addition, current surgical innovations have improved to preserve muscle, limit pain, reduce recovery time, and provide more favorable aesthetic outcomes. These innovative approaches allow patients with breast cancer to experience a higher quality of cancer care, which ultimately leads to better health outcomes.
Holy Name Medical Center
By Adam Jarrett, M.D, M.S., Executive Vice President and Chief Medical Officer
As one of only five hospitals in New Jersey and New York to receive the prestigious “5-star rating” from the Centers for Medicare & Medicaid Services for quality, Holy Name Medical Center makes the patient experience a priority at our Patricia Lynch Cancer Center (PLCC). Holy Name provides the full spectrum of state-of-the- art breast cancer care in order to achieve the best possible outcomes and quality of life for our patients. PLCC’s multidisciplinary breast cancer team specializes in providing culturally sensitive, cutting-edge cancer care, while always making certain we know every patient by his/her first name. Our Breast Center offers the leading edge in screening and diagnostic technologies within a warm and inviting environment. Patients seen in our Breast Center have access to world-class medical oncologists and breast surgeons, who navigate the various needs of breast cancer patients. Holy Name recently expanded breast surgical services with the addition of a second fellowship-trained breast surgeon. Both breast surgeons are skilled in advanced oncoloplastic breast surgery. They collaborate closely with plastic/ reconstructive surgeons to provide patients with excellent medical and aesthetic results. PLCC also offers a range of clinical trials for patients with breast cancer who are interested in expanding the frontiers of cancer care.
Jersey Shore University Medical Center, Hackensack Meridian Health
By Verda Hicks, M.D., FACS, FACOG, Chief, Gynecologic Oncology, Medical Director, Gynecologic Oncology, Hackensack Meridian Health Cancer Care in Monmouth, Ocean and Middlesex Counties
The use of genomic testing for targeted therapy of tumors is a tremendous advancement in the treatment of breast cancer, as well as many other cancers such as cervical and ovarian. This type of “precision medicine” uses information about a person’s genes and proteins to prevent, diagnose and treat their disease. As a scientific field that has progressed a great deal in the past decade, this knowledge opens a whole new area of therapies that were previously unavailable in the fight against cancer.
Today, we are able to utilize targeted therapies—which are drugs or other substances—that block the growth and spread of cancer. They allow physicians to use a particular therapy that affects the target (cancer) in a way that interferes with specific molecules that are involved in the growth, progression and spread of cancer. Many different targeted therapies have been approved for use in cancer treatment, and more continue to be developed by physicians and researchers who are committed to finding cures and helping patients live longer. In fact, at Jersey Shore University Medical Center, we are actively involved in clinical trials that are in development, such as a new trial for ovarian cancer. Offering these advanced treatment options and being involved in exciting clinical research is part of the medical center’s commitment to provide exceptional cancer care, close to home.
Rutgers Cancer Institute of New Jersey
By Deborah Toppmeyer, M.D., Chief Medical Officer, Professor of Medicine at Rutgers Robert Wood Johnson Medical School
For the past decade, Rutgers Cancer Institute of New Jersey has been using robotic surgery as a standard of care to treat gynecologic malignancies. Because robotic surgery utilizes smaller incisions, patients often go home the same day, and their overall recovery and return to normal activities is quicker. We perform robotic techniques at our flagship facility, Robert Wood Johnson University Hospital in New Brunswick, an RWJBarnabas Health facility. We are using robotic surgery in conjunction with an infrared camera for sentinel lymph node detection, and we’re performing single-site robotic surgery, which uses only one incision through the belly button. As New Jersey’s only National Cancer Institute-designate Comprehensive Cancer Center, Rutgers Cancer Institute remains on the cutting edge in developing and offering the latest anti-cancer therapeutics in the treatment of breast cancer and other malignancies. Along with immunotherapy and personalized treatments resulting from genomic analysis, Rutgers Cancer Institute is teaming up with the Big Ten Cancer Research Consortium in offering an innovative clinical trial opportunity for patients with triple-negative breast cancer, which is one of the most challenging forms of breast cancer to treat.
By John F. Bonamo, M.D., MS, FACOG, FACPE, EVP, Chief Medical and Quality Officer
Our system is taking an active in role in educating our communities about the importance of healthy pregnancies to ensure positive outcomes for moms and babies. On the clinical side, in 2015, we established the RWJBarnabas Health OB Collaborative to assist healthcare providers by instituting evidence-based protocols to address the rising concerns of maternal health. The collaborative brings together the top minds in obstetrics care across the system and takes a multidisciplinary team approach by actively engaging physicians, nurses and support service leadership. Together we are focused on improving the quality and safety of healthcare services delivered to women throughout their pregnancies, deliveries and their postpartum period, and to ensuring that every woman has a voice when it comes to her maternal care. The RWJBarnabas Health’s OB Collaborative meets regularly to identify best practices, review and implement evidence-based protocols, address challenges, and evaluate and implement ways to improve maternal care.
Trinitas Comprehensive Cancer Center
By Barry Levinson, M.D., Medical Director
If you know anyone who is overweight and has been diagnosed with stage two or three breast cancer, a new study being undertaken at Trinitas Regional Medical Center could provide important answers about weight loss and how it relates to the disease.
Trinitas is participating in a potentially groundbreaking study that looks at the impact of weight loss on breast cancer recurrence. The Breast Cancer Weight Loss (BWEL) study is sponsored by the National Cancer Institute and the Alliance for Clinical Trials in Oncology. The study admits overweight and obese women who are diagnosed with early-stage breast cancer to test if weight loss can help prevent their disease from returning. The BWEL Study offers both preventative and curative medicine to our breast cancer survivors seeking physical fitness and wellness. It presents a unique way of looking at the relationship between weight and cancer, as there have been no studies examining the effect of weight loss and the risk of breast cancer recurrence. If you have been diagnosed with stage two or three breast cancer within the last 12 months or have completed surgery and chemotherapy and are interested in participating in the Trinitas Weight Loss Study, please contact us at (908) 994 8728.
Valley–Mount Sinai Comprehensive Cancer Care
By Ephraim Casper, M.D., Chief Medical Officer
At Valley-Mount Sinai Comprehensive Cancer Care, women with cancer are cared for by disease specialized physicians who are focused on developing and implementing emerging technologies. For example, IORT (intraoperative radiation therapy) is a breakthrough breast cancer treatment in which an entire course of radiation therapy is delivered in the operating room at the time of a lumpectomy. For many women, this can eliminate weeks of post-surgery radiation, adding convenience, reducing cost, and improving quality of life. Radioactive seed localization allows the surgeon to pinpoint breast tumors, so that the precise area of concern is identified and removed. Advances in drug therapy, unimaginable a few years ago, are making dramatic differences that really matter to women with breast or gynecologic cancer. Analysis of the genes that drive each individual tumor allow personalized treatment. Selective use of new classes of drugs, CDK (cyclin-dependent kinase) 4/6 inhibitors, PARP inhibitors and immunotherapy, improves outcomes and reduces side effects. We are passionate about advancing therapy to help our patients live healthier lives, and offer unique clinical trials and novel treatment modalities. These innovations are offered at the Luckow Pavilion in Paramus, where comprehensive care for women with cancer is available under one roof.
Hackensack University Medical Center, John Theurer Cancer Center, Hackensack Meridian Health
By Deena Mary Atieh Graham, M.D., Breast & Gyn Medical Oncologist
The use of clinical genomic testing has revolutionized treatment paradigms and standards for patients diagnosed with early stage breast cancer. Tests such as the Oncotype DX, MammaPrint, etc. have become part of the standard of care and have allowed us to better tailor and personalize therapy so that patients receive the most appropriate treatment modalities. These tests look beyond the anatomy (i.e. size, grade or how the cells look under the microscope) of a cancer and provide information on the behavior or biology of a tumor. For example, we can identify patients for which chemotherapy will have little to no benefit and hence be avoided—leading to less short- and long-term side effects for patients. Alternatively, we can provide patients with additional information as to the degree of benefit that chemotherapy can provide, and therefore allow patients to make the most well-informed decisions possible about their cancer care. The use of these tests has been fully validated in lymph node negative breast cancer for the last number of years and is likely to be expanded into lymph node positive disease as well. Reflective of this, the staging of breast cancer now incorporates these predictive and prognostic “scores.”