2007 Cancer Annual_prod5 - St. Joseph Medical Center

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Focus on Non-Small Cell Lung Cancer In-Depth Site Study (continued) cancer can benefit from postoperative adjuvant chemotherapy. For locally advanced lung cancers, curative surgical resection has been made possible by pretreatment with neoadjuvant concurrent chemotherapy and radiation. More than ever before, the safe and effective delivery of modern lung cancer care is dependent upon close cooperation and constant communication between health care providers with many different areas of expertise. At St. Joseph Medical Center, coordination of multidisciplinary lung cancer care in The Thoracic Oncology Center is accomplished in several different ways. Table 1 Number and gender distribution of patients with non-small cell lung cancer evaluated and/or treated at St. Joseph Medical Center, by year. Year Patients Females 2001 67 52.2% 2002 69 59.4% 2003 71 50.7% 2004 77 40.3% 2005 77 55.3% 2006 64 54.7% New patients seeking lung cancer care at St. Joseph Medical Center are encouraged to undergo initial evaluation in the multidisciplinary Thoracic Oncology Clinic. During a single clinic visit, the multidisciplinary team revolves around the patient both figuratively and literally. Lung cancer patients are evaluated by a thoracic surgeon, medical oncologist, radiation oncologist, smoking cessation counselor and nurse coordinator. Patients, together with their loved ones, meet with all the above health care professionals without even having to move from one room to another. Not only for local patients, but especially for patients traveling long distances in order to obtain their care at St. Joseph Medical Center, eliminating the need for multiple trips to different offices on different days both facilitates and expedites multidisciplinary evaluation and treatment. Later on the same day of the multidisciplinary evaluation, cases are discussed in a multidisciplinary conference during which biopsy slides are reviewed by participating pathologists, and radiological imaging studies are reviewed by participating radiologists. Within hours of a multidisciplinary evaluation, based upon group consensus at the Tumor Conference, a comprehensive evaluation and treatment plan is formulated for each lung cancer patient with input from surgeons, medical oncologists, radiation oncologists and pulmonologists. The close cooperation and streamlined communication between all of the above specialists makes it possible to provide complex, comprehensive care that is individually tailored to each patient’s specific circumstances. Communication between patients and their physicians is of utmost importance. Such communication can be particularly confusing and complicated when multiple treating physicians are involved. The Thoracic Oncology Center at St. Joseph utilizes nurse coordinators to oversee scheduling of tests, 10 | ST. JOSEPH MEDICAL CENTER sjmcmd.org
Table 2 Geographic distribution of patients evaluated and/or treated at St. Joseph Medical Center between 2001 and 2006. Baltimore County Baltimore City Harford County Carroll County Other 2.4% 6.1% 9.6% 13.4% appointments, treatments and surgery for each patient undergoing multidisciplinary evaluation and treatment. The nurse coordinators meet the patients at their multidisciplinary clinic appointment and participate in the multidisciplinary Thoracic Oncology conference. After a patient’s case is discussed at the multidisciplinary conference, their nurse coordinator reinforces the management plan to them on behalf of all of the physicians involved. Having a nurse coordinator involved in their care greatly alleviates patients’ anxiety and increases patients’ confidence as well as their knowledge about their care. Aggressive Pretreatment Staging 68.5% 0 5 10 15 ... 60 65 The optimal management of non-small cell lung cancer is highly dependent upon the stage of the disease. A serious consequence of incorrect staging is that it can lead to incorrect treatment. In some cases, standard radiological imaging studies may fail to identify the true extent of a patient’s disease, which is how incorrect staging can occur. In our efforts to maintain an unsurpassed standard of excellence in radiological imaging, The Cancer Institute at St. Joseph Medical Center has recently acquired a state-of-the-art PET/CT scanner with which high-speed/high-resolution CT images of a patient can be obtained simultaneously with PET images. In order to enhance the diagnostic usefulness of this imaging and in order to avoid performing a separate contrast-enhanced CT scan, intravenous contrast is administered during the PET/CT scan, allowing both scans to be accomplished at once. The high-quality imaging that results allows detection of very subtle but critically important metastatic disease that might otherwise go unrecognized. In non-small cell lung cancer, involvement of lymph nodes in the mediastinum has a major negative impact on the likelihood of accomplishing curative surgery. While CT scans and PET scans can often identify metastatic involvement of mediastinal lymph nodes, microscopic involvement of these nodes with tumor can easily be missed. Mediastinoscopy is a minimally invasive outpatient surgical technique in which mediastinal lymph nodes are sampled and microscopic metastatic disease can be identified. At St. Joseph Medical Center, mediastinoscopy is used routinely in non-small cell lung cancer patients in order to rule out mediastinal lymph node involvement before surgical resection is undertaken. Often, patients whose CT scans and PET scans failed to reveal any metastatic cancer in their mediastinal lymph nodes are found to have microscopic lymph node involvement using mediastinoscopy. Knowing about this type of microscopic metastatic disease is vital before treatment is undertaken, Never Smoked 10.4% Table 3 Smoking status of patients with non-small cell lung cancer evaluated and/or treated at St. Joseph Medical Center between 2001 and 2006. Previous Smokers Current Smokers Unknown 3.1% 30.1% 56.5% 0 10 20 30 40 50 2007 THE CANCER INSTITUTE ANNUAL REPORT | 11
Page 1 and 2: 2007 Annual Report | 2006 Statistic
Page 3 and 4: “This way, the patient is assured
Page 5 and 6: The Cancer Institute Cancer Liason
Page 7 and 8: Cancer Institute Registry Activity
Page 9: Focus on Non-Small Cell Lung Cancer
Page 13 and 14: community setting, The Thoracic Onc
Page 15 and 16: treat ever increasing numbers of pa

2007 Cancer Annual_prod5 - St. Joseph Medical Center

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