Cancer Center Annual Report, 2006 - Hartford Hospital!

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clinical programs l s p e c t r u m o f t h e i r c a r e f r o m e a r l y d e t e c t i o n o n t s f u l t h r o u g h t h e t r e a t i n g p a t i e n Hematology The Hematology section of the Department of Medicine consists of six members, most of whom have dual appointments in oncology as well. Our newest member is Dr. Sean Mullally fresh out of training from the Tufts program at Baystate Medical Center in Springfield. The section continues to have an active inpatient service of referrals, and 10 to 20 primary care hematologic patients most of whom have leukemia, high-grade lymphoma, or complications of therapy, mainly neutropenic sepsis and pain. There is a small group of end-of-life patients on the palliative care service, also on our unit on B5E. The consult service consists of an array of pancytopenias, bleeding and clotting disorders and unusual hematologic ailments. We receive about 300 new referrals yearly in the hospital and office for new patients with leukemias, lymphomas, myelodysplasias, myeloproliferative disorders, and myeloma, as well as an equal number of benign ailments. Advances in treatment include newer agents for myelodysplasia, Revlimid, Decitibine, Vidaza; Dasatinib for patients with CML relapsing on Gleevec; continuing use of monoclonal antibodies in B-cell lymphomas (Rituxan, Bexxar, Zevalin, Campath); release of Revlimid for second line myeloma therapy. There also is a new oral iron chelator Exjade, which will probably replace Desferal. We have tended to send patients with high-risk hematologic disorders to transplant centers, mainly Harvard, and Yale, with some improvement in long-term survival likely. Newer diagnostic tests include the JAK-2 genetic mutation for myeloproliferative disorders like Polycythemia Vera and thrombocythemia; and a battery of FISH markers for a variety of malignancies, coordinated by our new hematopathologist Dr. Mnayer. We continue to have a collegial, friendly relationship with the University of Connecticut, and are an integral part of their teaching program. Fellows split their time between the two medical groups, Oncology Associates, and CMG, with 2 to 3 month rotations on each service, both inpatient and clinic; and also have had horizontal clinics for a half day per week in our offices in order to follow patients for prolonged periods. Approximately half the time we also have a medical resident rotating through the service, again dividing his time between the two offices on a week- by- week basis. Grand rounds topics this year included acute myelogenous leukemia (Firshein), and multiple myeloma (Dailey). Stephen Firshein, MD Division Chief, Hematology Medical Oncology Hartford Hospital’s Division of Medical Oncology provides state-of-the-art cancer care for patients with solid tumors and hematologic malignancies. As the overall United States population ages, the number of new cancer patients is projected to increase by 50% over the next 20 years. By participation in multi-institutional clinical trials through the Gynecologic Oncology Group (GOG), the National Surgical Adjuvant Breast and Bowel Project (NSABP), and the Cancer and Leukemia Group B (CALGB), patients throughout central Connecticut will have access to the newest available treatments. Dr. Robert Siegel is the Chairman of Hartford Hospital’s Institutional Review Committee and is the Medical Director of the Cancer Clinical Research Office. The Division of Medical Oncology has 12 board-certified medical oncologists, one advanced-practice oncology nurse practitioner, as well as a support staff of more than 35 oncology nurses, secretaries, and laboratory technicians. Although all members of the Division see a wide spectrum of cancers, several members do have particular areas of expertise. Dr. Stacy Nerenstone has worked closely with Dr. Joel Sorosky coordinating treatment of patients with a wide range of gynecologic malignancies. Dr. Robert Siegel collaborates with the physicians at the Dana-Farber/Partners CancerCenter and treats many patients with soft tissue sarcomas, malignant melanomas, and many other rare malignancies. Dr. Jeffrey Kamradt has research expertise in genitourinary oncology with particular interest in treating patients with advanced prostate cancer. Dr. Timothy Hong’s research has concentrated on gastrointestinal malignancies. Dr. Schauer, Dr. DeFusco, Dr. Nerenstone, and Dr. Baker have worked closely with Dr. Elizabeth Brady in the surgical department as part of the Partnership for Breast Care and have made the weekly breast cancer planning conference a very successful teaching conference. The inpatient medical oncology unit has been relocated to Bliss 5 in Hartford Hospital. 8 HARTFORD HOSPITAL CANCER PROGRAM
clinical programs t r e a t i n g p a t i e n t s t h r o u g h t h e f u l l s p e c t r u m o f t h e i r The Division remains committed to providing medical education to medical students, interns, resident physicians, and medical oncology fellows. Multidisciplinary educational patient care conferences are held in conjunction with the Departments of Surgery, Urology, Neurology, Thoracic Surgery, Gynecology, Pathology, and Radiation Oncology. In addition to Hartford Hospital’s weekly Oncology Tumor Board and monthly lymphoma rounds, a weekly breast cancer planning conference is held under the direction of Dr. Elizabeth Brady from the Department of Surgery. Outpatient treatments are currently provided at the Helen & Harry Gray Cancer Center as well as at satellite facilities in Avon, Windham, Southington, and Wethersfield. This is a very exciting time for medical oncology as a specialty. Many so-called targeted treatments with both less toxicity as well as greater efficacy are now available for a wide range of malignancies. Clinical studies that are currently in progress are investigating many new agents, which should become available within the next several years. We are very optimistic that the results of these basic research studies will provide far more options for our patients. Peter K. Schauer, MD, FACP Division Chief, Medical Oncology o n i o n c a r e f r o m d e t e c t e a r l y Nutrition Services The Registered Dietitians in the Cancer Program continue to assist and support cancer patients and their families by providing nutritional information, education and guidance during their treatment, and afterwards. A strong effort has been made to provide seamless patient care between the inpatient and outpatient setting. This has been very successful with our tube feeding patients. In addition to the direct patient care provided, nutrition education programs have been conducted at Hartford Hospital’s support groups (ovarian, brain, and prostate). Public outreach programs (Women’s Health Fair, Breast Cancer Awareness Month Program, and the Team Towanda annual fundraiser) had nutrition represented with a Dietitian to answer questions and distribute nutritional materials. Additional programs and patient support events the Dietitian has been involved in are New Beginnings, Celebrate Life, The Remembrance Service, The Fritts Symposium, and The Mary Mulready Sullivan Oncology Symposium. Articles for the column “Nutrition Tidbits” in the Cancer Program Newsletter have been successful and the Dietitian has provided healthy recipes for the Advanced Prostate Support Group Newsletter and in the Cancer Center Atrium. Education for professionals was achieved by mentoring 4 University of Connecticut Dietetic Interns during their Dietetic Internship. Guest lecturing at the School of Allied Health at the University of Connecticut and the University of New Haven helped stimulate potential interest in the area of cancer and the role of nutrition. The Cancer Center Dietitian taught the nutrition section for the Hartford Hospital School of Allied Health Radiation Therapy Technology Program and was an instructor for the Registry Review for new graduates of Radiation Therapy programs across the country. Ann Zogbaum, MS, RD Registered Dietitian Oncology Social Work Services The overall goal of the oncology social work team is to minimize the negative impact of cancer by offering supportive services as outlined in the Cancer Program’s mission statement. During the 2005-2006 fiscal year, our oncology social workers continued to provide psychosocial interventions for cancer patients and their families that included emotional support, advocacy, resource referrals, education, and guidance. HARTFORD HOSPITAL CANCER PROGRAM 9
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