Complete Cancer Care - Mercy Health Saint Mary`s

Transcription

Complete Cancer Care
The Lacks Cancer Center
Report to the Community
A One-stop Approach
to Cancer Care
After she was diagnosed with breast cancer, Ruth Chisnall had lots
of questions. In the past, getting answers would have required
considerable time, multiple appointments and a significant amount
of driving to the offices of different specialists.
As it was, Chisnall was able to get all her questions answered in
a single visit to The Lacks Cancer Center at Saint Mary’s Health
Care. In a conference room, she met with a multidisciplinary team,
including one of the area’s two fellowship-trained breast surgeons,
a radiation oncologist, a cancer resource specialist, a nurse navigator
and the center’s medical director, all willing to take as much time as
necessary to answer her questions.
“The thing that really impressed me is you have the benefit of the
whole team’s experience,” Chisnall said afterward. “I have a lot of
confidence in their ability to do what needs to be done.”
Getting answers and access to the best care wasn’t always that
easy for cancer patients in West Michigan. Richard Lacks, Sr., after
he was diagnosed with a rare form of cancer, made many trips to
the MD Anderson Cancer Center in Houston, far from his West
Michigan home. During one trip, he said he wished Grand Rapids
had a similar world-class facility.
Lacks didn’t see his dream come true. The Grand Rapids industrialist
died in May, 1999, one month after his father, John Lacks, succumbed to cancer. Thanks to his dream and his family’s generosity,
Saint Mary’s Health Care in 2005 opened The Lacks Cancer Center,
West Michigan’s only dedicated cancer hospital.
“While the facility itself is first-rate, it’s the people working in it who
distinguish The Lacks Cancer Center,” said Dr. David Baumgartner,
Saint Mary’s vice president of medical affairs.
“We had to get away from traditional thinking,” he said. “What are
the patient’s needs, and what are the services that need to be
brought to bear around that patient? It’s got to be centered around
what the patient’s needs are. It really takes a well-functioning team
to treat a complex disease like cancer.”
When Lacks Medical Director Dr. Thomas Gribbin began planning
the new center, he often remarked that a cancer patient in Grand
Rapids needed two things: a full tank of gas and a map. Cancer care
was scattered in hospitals and doctors’ offices throughout the area,
and patients routinely had to wait weeks for diagnoses and then
weeks more for treatment.
Gribbin’s “vision was ‘let’s make it easier for the patient, bring it all
together and have more-coordinated care,’” Baumgartner said.
TEAM APPROACH: The Lacks Cancer Center Medical
Director Thomas Gribbin (right) and a team of other
cancer specialists including Dr. Jamie Caughran (second
from right) and physician assistant meet with breast
cancer patient Ruth Chisnall.
Cover Photo REASSURING SMILE: Dr. Jamie Caughran meets
with breast cancer patient Karen McKenzie before performing surgery.
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DAVID BAUMGARTNER, MD
Vice President of Medical Affairs
At Lacks, everything a patient needs — all the specialists, equipment
and services — are in one place. Not only is that more convenient for
patients, but having all those specialists under one roof also allows for
easier consultations about cases.
“The communication piece is critical,” Gribbin said. “You get more
rational decisions that way.”
Another characteristic of The Lacks Cancer Center’s staff is “our global
concern for the patient,” Gribbin said. “This is a life-changing event, and
we need to understand that and treat that patient and the whole family.”
At Lacks, the time between diagnosis and treatment has been reduced,
often to a week, decreasing the patient’s anxiety. The center’s staff
offers a variety of services to each patient and their families. Each is assigned a nurse navigator to answer questions and guide them through
their treatment. A cancer resource specialist also meets with each
patient to work out any barriers to care, whether it’s arranging transportation to appointments or dealing with employment problems.
“We take into account not only a patient’s physical wellbeing, but their
emotional and spiritual wellbeing,” The Lacks Cancer Center Director
Kenda Klotz said.
Saint Mary’s plans to continue expanding the types of cancers treated
and the range of services offered at The Lacks Cancer Center, Phil
McCorkle, the hospital’s CEO said, adding, “We have a clear vision and
path of where we are going, incorporating innovative strategies, such
as research.” A Phase I clinical trial unit allows Saint Mary’s patients
to participate in the search for better cancer treatments, giving them
access to the latest therapies.
While some cancers still are incurable, Saint Mary’s is deeply involved
in the search for more-effective treatments and possible cures.
“I think we’ve come a long way in treating cancer,” Gribbin said, “and
we stand at the edge of a revolution.”
CARRIE NESTELL
National Community Cancer Center Manager
A NATIONALLY
RECOGNIZED PROGRAM
The Lacks Cancer Center is one of 30
hospitals in the country — and the only one
in West Michigan — selected to participate
in a National Cancer Institute program to
increase cancer treatment access, improve
the quality of care and expand research.
As a member of the National Community
Cancer Centers Program (NCCCP), Saint
Mary’s and the other 29 hospitals share
information on the latest research and most
effective treatments, assuring Lacks patients
get the highest level of care available anywhere in the country.
“That’s the exciting thing about this project,”
said Carrie Nestell, who manages the
program at Saint Mary’s. “You can get outstanding care locally without having to drive
long distances.”
The National Cancer Institute created the
program to give patients in underserved rural, suburban and urban areas access to the
best care. The NCCCP has six goals:
• Increasing participation in clinical trials
• Sharing information through a national
computer network
• Collecting tumor specimens for research
• Improving patients’ quality of life through
palliative care
• Offering the best care based on the
scientific evidence of what works and
what doesn’t
THOMAS GRIBBIN, MD
KENDA KLOTZ
Medical Director
Director
• Reducing health care disparities
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EXPANDING
SERVICES,
EXTENDING
REACH
The Mercy Cancer Network offers more than
200 board certified cancer care physicians,
including oncologists, radiation oncologists
and surgeons, as well as oncology nurses
and other cancer-related specialists. As part
of the network, The Lacks Cancer Center is
one of 17 locations across the state, allowing
for compassionate and quality patient care
to be given close to home.
Saint Mary’s also recently formed a regional
health care system with Muskegon-based
Mercy Health Partners to improve access
to all types of medical care for patients
throughout West Michigan, including those
with cancer.
The new Mercy Health system includes
all Saint Mary’s locations; the Advantage
Health/Saint Mary’s Medical Group; Mercy
Health Partners hospitals and physician
offices in Muskegon, Shelby and Norton
Shores; Mercy Hospital Cadillac; and Mercy
Hospital Grayling. The new regional system
will provide more services throughout West
Michigan, improve communication between
patients and health care providers and give
patients easier access to specialists, including those at The Lacks Cancer Center.
The Mercy Health system, to be phased in
over the next two years, will offer the expertise of more than 1,100 physicians and other
health care providers, while retaining Saint
Mary’s commitment to its community and
personalized care.
Saint Mary’s and Mercy Health are part of
Trinity Health, one of the largest Catholic
health care systems in the country.
Thoracic
Surgery
The patient is 30 years old, a single mother of two. She’s a smoker,
and the spot that showed up during a CT scan looks ominously like
lung cancer.
Amber Hammerlind had been coughing, was short of breath and
felt tightness in her chest. An X-ray showed nothing, so her doctor
ordered the CT scan, which detected the shadow on her right lung.
Dr. Bruce Shabahang, medical director of thoracic oncology at
The Lacks Cancer Center, presented her case at a weekly meeting
of the hospital’s pulmonary tumor board, a multidisciplinary team of
physicians and other staff members. A needle biopsy was deemed
too risky, since the nodule was close to Hammerlind’s heart. The
safest way to determine if the nodule was cancer, Shabahang
decided, was for him to operate on her with one of the hospital’s
two da Vinci® robots.
The minimally invasive surgery requires only a few small incisions.
“It’s substantially less traumatic,” Shabahang said. “Less muscle
cutting, less bone fracturing — that leads to less pain and quicker
recovery.”
Many of the cases that come before the pulmonary tumor board
are lung cancer, still one of the deadliest forms. “That makes early
detection and smoking cessation two of the most important ways of
improving survival,” Shabahang said.
“This looks exactly like cancer,” he said, examining the CT images
minutes before operating on Hammerlind, but he added: “Hopefully,
this will be benign, and we can all go home happy.”
GOOD NEWS: After
performing lung
surgery on Amber
Hammerlind, Dr. Bruce
Shabahang assures
her grandmother, Pat
Wagner, and aunt,
Michelle Campbell, that
the nodule he removed
was not cancerous.
“Couldn’t have turned
out better,” he said.
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COLLABORATION: Dr. Bruce Shabahang discusses cases with a team of doctors, nurses, social workers and other staff members,
including Clinical Nurse Specialist Chris Werkema, during a weekly Pulmonary Tumor Board meeting (left photo). A team, led by
Shabahang, prepares to perform lung surgery using the da Vinci robot (center photo). The robot’s tiny instruments (right photo)
allow Shabahang to perform minimally invasive surgery, reducing blood loss and allowing faster recovery for the patient.
He made three small incisions in her chest, allowing the
surgical team of nurses and technicians to insert two instruments and a tiny camera, all attached to the robot arms
over the table. A few feet away, Shabahang sat down at a
console and took hold of the da Vinci’s controls. Guided by a
three-dimensional image, he moved the instruments inside
Hammerlind’s chest.
The da Vinci allows him to operate with greater precision than
he could with conventional laparoscopic surgery, and he can
reach areas inside a patient that otherwise would require a
large incision. The instruments inside Hammerlind were
extensions of the surgeon’s hands, turning when he turned
his wrists, cutting and cauterizing to minimize blood loss.
He probed her right lung, grasped the tissue with an instrument and held it up. Taz Kleyn, a registered nurse first assistant,
inserted an instrument through one of the small incisions and
placed a staple between the lung and the suspected tumor.
Shabahang cut the piece free and inserted it in a tiny bag,
which Kleyn withdrew. Shabahang stepped away from the
console and dissected the nodule.
“Just looking at the outside, it looks benign,” he said. But
he couldn’t be sure until a pathologist examined it under a
microscope. Minutes later, the call came. The nodule was
not cancer. It was a granuloma, a collection of inflamed cells
caused by a fungal infection.
“I’ve got great news for you all,” Shabahang told Hammerlind’s
parents, grandmother, an aunt and other family members in a
nearby waiting room. “She should be fine.”
Their relief was palpable. The fungal infection, he assured
them, could be treated with medication.
“Couldn’t have turned out better,” he said. “I’m very pleased.
This is a joyful moment for all of us.”
A few weeks later, Hammerlind tossed a football around her
father’s backyard with her sons, Jon, 10, and Kyle, 6. For her,
the scare was a wakeup call.
“Oh, I was so relieved,” she said. “I didn’t want to leave them.”
And that, she said, is why she has quit smoking.
QUICK RECOVERY: A few weeks after undergoing lung surgery
with the da Vinci robot, Amber Hammerlind plays touch football
with her sons, Kyle, 6, and Jon, 10.
BRUCE SHABAHANG, MD
Medical Director of Thoracic Surgery
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Breast Cancer
Minutes before she was wheeled in for breast cancer surgery,
Karen McKenzie was relaxed.
“I’m fine,” she said. “Knowing what’s going to happen and what to
expect puts me at ease.”
She knew what to expect because from the moment of her diagnosis, a multidisciplinary team of doctors, nurses, social workers
and other staff members at The Lacks Cancer Center had done
all they could to keep her informed, expedite her treatment and
alleviate her anxiety. That’s the philosophy behind the center —
making the entire experience as comfortable and convenient for
the patient as possible.
“In other hospitals, if you have to get surgery, you’re transferring
from building to building,” said Dr. Jamie Caughran, medical director for the Saint Mary’s Comprehensive Breast Center, part of The
Lacks Cancer Center. “Here it’s all in one place.”
While Saint Mary’s Health Care for years has offered a range of
services for breast cancer patients, in September 2010 it formed
the Comprehensive Breast Center, the only facility of its kind in
West Michigan, bringing all those services together in The Lacks
Cancer Center. Under the center’s Rapid Results Program,
a patient can go from initial diagnosis to testing in a matter of
24 hours.
“From diagnosis to surgery typically is under two weeks,”Caughran
said. “The patient experience is so much better.”
Karen McKenzie’s breast cancer first showed up as an ominous
spot in a routine screening mammogram. With no family history of
cancer, she was certain it was benign, but later tests confirmed it
was invasive ductile carcinoma, the most common form of breast
cancer. McKenzie’s initial impulse was to undergo a double mastectomy, get it all out, but she changed her mind after learning
from her health team that research has shown the less-invasive
lumpectomy is virtually as effective at avoiding a recurrence of
cancer as the more extreme double mastectomy.
“That told me I was at the right place,” McKenzie said. “My comfort
was in knowing they’ve seen it all and done it all.”
Beyond the technical expertise, McKenzie was impressed with
the personal care at The Lacks Cancer Center, “a sense of calming
and a sense of caring — those are the words I would use,”
she said.
With a detailed treatment plan in hand, she arrived one morning
for surgery, with just one question left to be answered. “What
kind of music would you like to have played in the operating
room?” Dr. Caughran asked. “Elton John and Jimmy Buffet,”
McKenzie answered. So it was, as she was wheeled into the OR,
a Jimmy Buffet tune emanated from a CD player.
“Before you know it, your operation will be over,” Dr. Keith Getz,
an anesthesiologist, assured her. “You’re doing great.”
EXPERT CARE: Dr. Jamie Caughran, a breast surgery
specialist, and surgical technician Staci Enderle
begin surgery on Karen McKenzie.
RELAXED SETTING: Breast cancer patient Karen McKenzie chats
with her husband, Mark, while nurse Angela Ichinose begins
administering a chemotherapy treatment. Looking on, patient
Karyn Webber-Swanson, nearing the end of her treatments,
offers encouragement.
6
“MY COMFORT WAS IN KNOWING
THEY’VE SEEN IT ALL AND DONE IT ALL.”
Other team members — nurse Lou Sacha and surgical technician
Staci Enderle — readied the instruments Caughran, a fellowshiptrained breast surgeon, would need. Caughran inserted a port in
the right side of McKenzie’s chest, which later would be used to
administer cancer-fighting drugs.
She then removed lymph nodes and sent them for the pathology
department to determine if the cancer had spread beyond the lump
in the left breast. While awaiting that call, Caughran removed the
cancerous lump and surrounding tissue. The call from pathology
brought good news: the lymph nodes were cancer free, indicating
the breast cancer had been caught early.
JAMIE CAUGHRAN, MD
Medical Director of Comprehensive
Breast Center
With McKenzie on her way to the recovery room, each member of
the surgical team signed a card, “wishing you a speedy recovery.”
She went home the following day and was back at her job as a bank
branch manager a few days later.
A few weeks after surgery, McKenzie met with a Saint Mary’s
medical oncologist who explained the series of chemotherapy and
radiation treatments she would undergo to assure that every last
cancer cell was eradicated.
As she began her weeks of chemotherapy, to be followed by radiation
treatments, McKenzie said she couldn’t be happier with the care she
was getting at The Lacks Cancer Center.
RELAXED SETTING: Breast cancer patient Karen
McKenzie, accompanied by her mother, Elenor Doerr,
and attended by medical assistant Beth Van Iterson,
receives chemotherapy treatments in The Lacks Cancer
Center’s infusion area, which was designed to
accommodate friends and family members.
“I feel very blessed,” she said. “It was just a routine screening
mammogram that caught it. That routine mammogram is priceless
to me.”
ON THE JOB: While periodically undergoing
treatments at The Lacks Cancer Center, Karen
McKenzie was able to continue working, meeting
with customers at the bank branch she manages.
“I’m not defined by cancer,” she said.
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PREVENTING CANCER:
MAMMOPLUS
®
After genetic testing
showed she had inherited a mutation putting
her at a high risk for
For most of her life, Amy Johnson didn’t know a mutation was lurking in her genes, greatly increasing her risk
of developing breast and ovarian cancer.
Her mother was diagnosed with breast cancer at age 50
and died two years later, but “I was told by a doctor it
was not genetic,” Johnson recalled. “It gave me a false
sense of security.”
She was unaware her family history was one factor
placing her at a higher than average risk of developing breast cancer. Fortunately, The Lacks Cancer Center,
through its MammoPlus program, offers all women
who come in for a screening mammogram, the latest in
digital mammography — which provides a more accurate picture than traditional mammography — plus an
assessment of each woman’s lifetime risk of developing
breast cancer, conducted through a brief questionnaire.
“THEY TOOK A BAD THING
AND MADE IT AN
AWESOME EXPERIENCE.”
Those whose risk is deemed above average are offered
an appointment with the High Risk Program for a more
in-depth assessment. If they are confirmed to be at a
high risk, they are offered closer monitoring, including
annual mammograms and MRI images and twice-a-year
examinations, as well as the option of taking Tamoxifen
or Evista. While those drugs reduce the risk of breast
cancer by 50 percent by blocking estrogen in the breast
tissue, they must be taken every day for five years and
are not recommended for women at risk of blood clots.
Johnson’s mammogram was negative, but the high risk
assessment placed her at a high risk of developing
breast cancer. She chose another option offered by the
Comprehensive Breast Center: genetic testing. She was
stunned when the simple test showed she carried a gene
mutation, one of two known to increase a woman’s risk
of developing breast cancer to 87 percent and ovarian
cancer to 44 percent.
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developing breast
cancer, Amy Johnson
(left) underwent a
double mastectomy
and hysterectomy. Her
friend, Rhonda Brewer
(right), whose mother
had breast cancer, was
considering the same
test offered under the
Comprehensive Breast
Center’s MammoPlus
program.
“I wanted to be proactive about my health,” Johnson said,
particularly because her husband had died of a heart
attack 10 years earlier, leaving her to raise their two sons.
In the fall of 2010, Johnson, a second grade teacher,
underwent a hysterectomy, performed by Dr. Kevin
Brader with a da Vinci robot. Weeks later, Dr. Jamie
Caughran performed a double mastectomy, followed
by reconstructive surgery. The two surgeries reduced
Johnson’s risk of developing breast or ovarian cancer
to less than five percent. She was 50, the same age at
which her mother was diagnosed with breast cancer.
The physicians and other staff members at The Lacks
Cancer Center “were just so kind and compassionate,”
Johnson said, adding she was surprised at the range
of complementary services she was offered, including
massage therapy.
“Who’s ever heard of that?” she asked. “I don’t think it
can get any better than this. They took a bad thing and
made it an awesome experience.”
Gynecologic
Cancer patient Kathie Eding never has forgotten what nurse
Michelle Weller told her the first time they met at The Lacks
Cancer Center.
“She said, ‘There will be times we will laugh together. Unfortunately, there will be times we will cry together, but we’ll
always be like family,’” Eding recalled.
In 2007, Brader became the first surgeon in West Michigan
to perform a hysterectomy with the da Vinci robot. Since
then, he has become a da Vinci pioneer, performing more
than 900 robotic operations as of early 2012, more than all
but a few physicians in the country. He trains other surgeons
on using the da Vinci.
In addition to performing surgery, he supervises the chemotherapy treatments for his patients.
“UNFORTUNATELY, THERE WILL BE
TIMES WE WILL CRY TOGETHER,
BUT WE’LL ALWAYS BE LIKE FAMILY.”
After she was diagnosed with a rare and aggressive form of
uterine cancer, Eding’s gynecologist referred her to Dr. Kevin
Brader, a Lacks Cancer Center surgeon who specializes in
treating gynecologic cancers.
“The first time I walked through those doors, I was all teary
eyed,” Eding said. “I walk in there now, instead of tears, I
have a smile on my face.”
Brader did not downplay the seriousness of her cancer, but
Eding felt assured her care was in good hands. A week after
her first visit, Brader performed a hysterectomy with the
da Vinci Surgical System. Eding went home the next day.
“I asked Dr. Brader, ‘So do I have any restrictions?’ He said,
‘Nope.’ ‘So can I go for a walk?’ ‘Yup, you can go for a walk.’”
Brader said his patients usually are surprised when he tells
them they have few restrictions. “I almost think I should give
them restrictions,” he said. “Because they think I should.”
Eding had just finished her fourth and final chemotherapy
treatment and soon would begin a series of 25 radiation
treatments. She could have those treatments closer to her
Allegan County home, but “I just feel comfortable here,”
she said.
That’s because the Lacks staff knows that treating the
cancer is not enough. They strive to treat patients and their
families, making them as comfortable as possible through
an extremely difficult time.
“It’s all about the patient,” Michelle Weller, Brader’s nurse,
said. “It’s so traumatic when they come in. I’m here to
support them. We’re a team. We do become like family.”
“I feel so fortunate to be here,” Eding said. “I think it’s
important to have trust. I trust Dr. Brader. Like Michelle said,
‘We’re like family.’”
The experience has strengthened her faith and taught her
to appreciate what many take for granted, such as family,
friends, and the beauty of nature. “I feel blessed,” Eding
said. “If I become a better person because of this, then
I’m blessed.”
The robotic surgery not only is less traumatic for patients,
but it allows the surgeon to do things that were difficult, if
not impossible, with traditional surgery, such as accessing
certain areas of the anatomy.
TREATING THE
FAMILY: Dr. James
Kane answers questions from patient
Kathie Eding and her
husband, Mike, about
the series of radiation
treatments she will
undergo. The Lacks
Cancer Center staff
members recognize
KEVIN BRADER, MD
Medical Director of Gynecologic
Cancer Program
that cancer affects not
only the patient, but
the entire family.
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Gastrointestinal
By the time EJ Horricks learned he had colon cancer, it had spread
to his liver. He had a section of his colon removed, but doctors at
the hospital where he got the grim diagnosis said there was nothing
more they could do. Go home. Put your affairs in order.
But Horricks wasn’t ready to give up, so he sought a second opinion
at The Lacks Cancer Center at Saint Mary’s Health Care. While
doctors there could not promise a cure, they offered something
all cancer patients need: hope. Not false hope, but hope based on
sound scientific evidence and a skilled team with knowledge of the
latest techniques for fighting cancer.
“It’s not hope to promise something that can’t happen,” said Dr.
Thomas Gribbin, the center’s medical director. “Hope is about ‘can
we accomplish what’s important to you?’ If they say, ‘I want to live
a little longer,’ we’ll help them do that.”
Through an innovative combination of procedures and treatments,
Lacks doctors would try to shrink the three tumors in Horricks’ liver
and then surgically remove them, they told him.
“We met with the whole team that Friday,” Horricks recalled. “We
walked out of there at 6 o’clock in the evening, and we had a plan.
We had people we had confidence in. It was impressive. We went
from ‘go home and die’ to ‘we have hope here.’”
His doctors first administered a series of chemotherapy treatments
to shrink the tumors. Then Dr. Matthew Tiede, an interventional
radiologist, performed a portal vein embolization, inserting metal
coils in the blood vessels feeding the right lobe of Horricks’ liver,
the area where the three tumors were growing. Over the coming
weeks, as the right lobe starved for lack of blood, the left lobe grew
to compensate for the shrinking portion.
A month and a half later, Dr. Laurence McCahill, medical director of
surgical oncology at Lacks, performed a six-hour operation, removing the half of Horricks’ liver that included the shrunken tumors.
“I feel really good right now, best I’ve felt in two years,” Horricks said
a year after the surgery. “The Lacks Cancer Center is incredible. I’ve
never had better care.”
By then, his liver had regrown to its original size. A series of CT and
PET scans over the months following surgery showed no trace of
cancer. But then a PET scan in May 2011 detected a small tumor
in his liver. Horricks met with McCahill and decided to undergo a
second operation.
The following month, Horricks’ wife, Elizabeth, other family members and friends again gathered at Lacks, while a team of physicians,
nurses and assistants, led by McCahill, reopened his chest and
slowly worked their way toward the tumor. McCahill was concerned
that the tumor was next to a major artery.
“We’ve just found the lesion now,” he announced two hours into the
surgery. “I can feel the tumor.”
TEAM WORK: Dr. Laurence McCahill (left), assisted by Registered
Nurse First Assistant Taz Kleyn (right) and Dr. Ali Fouladi (center),
removes a cancerous tumor from EJ Horricks’ liver.
REASSURANCE: Family members and
a nurse comfort EJ Horricks before he
undergoes surgery for cancer that spread
to his liver from his colon.
10
Nurse Ginger Mileski picked up a telephone and updated Horricks’
family in a nearby waiting room. Three pairs of hands — McCahill’s,
Dr. Ali Fouladi’s and registered nurse first assistant Taz Kleyn’s —
carefully probed inside Horricks’ chest.
Four and a half hours after the surgery began, McCahill removed a
portion of Horricks’ liver and placed it in a plastic pan. He sliced into
it, exposing the white tumor.
After closing the incision, he met with Horricks’ family. “I was pretty
pleased with how it went,” he told them. “Hopefully, this will be his
last liver resection. Hopefully, he’ll be good.”
Horricks shares that hope. Six weeks after that operation, he sat in
the living room of his home 50 miles from Grand Rapids and looked
out at the river flowing past. A plaque on the wall said: “Sorrow
looks back. Worry looks around. Faith looks up.” A Bible was on the
table next to his chair. A year and a half after his first doctors offered
him no hope, Horricks was alive and optimistic, although he knows
when it comes to this kind of cancer, there are no guarantees.
“I’ve got 2,000 people praying for me,” he said. “I’m a firm believer in
the power of prayer. Eventually, somebody’s going to come up with
a cure. My job is to stay healthy until that cure.”
He rode an off-road vehicle up the lane to his garden, where his two
grandchildren, Ellie, 8, and Micah, 7, met him. A third grandchild —
a girl — was born a few days later.
“I’m determined to stay healthy until that baby’s wedding,” Horricks
said, “so I can dance at her wedding.”
RECOVERING AT HOME: EJ Horricks decided to have his cancer
surgery at The Lacks Cancer Center after meeting with the staff.
“Thank goodness we did,” he said, following surgery. “We were
so impressed with Saint Mary’s.”
POWER OF PRAYER: Horricks and his family attend church every
Sunday. “I’m a firm believer in the power of prayer,” he said.
LAURENCE McCAHILL, MD
Medical Director of Surgical Oncology
LOVE OF FAMILY: Six weeks after his second liver surgery, Horricks
hugs his grandchildren, Ellie, 8, and Micah, 7. “So what are we going
to do this afternoon, kids, go swimming?” he asked.
11
Financial
The patient was sitting at a table in the corner of her hospital room
when cancer resource specialist Dan Sherman knocked on her door.
Jo Ann Rogers had been diagnosed with acute myeloblastic leukemia days before. She was on Medicare, but, without supplemental
insurance, the retired cab driver faced monthly bills of $560 for her
treatment. “I started worrying about how I was going to pay for it,”
she said. “There was no way I could afford this.”
That’s when Sherman walked into her room, reviewed her financial
situation and signed her up for a supplemental Medicare policy
that would cover her treatments for $25 a month. As he got up to
leave, Rogers thanked him. “You’re welcome,” Sherman said. She
thanked him again, and he again said she was welcome. Rogers
grasped his arm.
“Dan, you just don’t get it,” she said. “I was planning my funeral
when you walked into the room.”
Until Sherman showed her otherwise, Rogers figured she couldn’t
afford to live. “I was planning on dying,” she said.
The program no longer is a pilot, but a permanent service offered
to The Lacks Cancer Center patients. Whereas each patient is
assigned a cancer resource specialist to help them with any social,
psychological or other issues that interfere with treatment, only if
a patient needs special financial guidance, are they referred to a
clinical financial consultant.
“They get involved with anything, like if someone’s lost their job
because they have cancer,” center Director Kenda Klotz said.
“What if I don’t have insurance? What if I can’t make my mortgage
payment? We try like crazy to get in front of the crises.”
Sherman, with his eclectic background in psychology and accounting, works full-time, helping patients overcome financial burdens,
whether it’s finding them insurance to cover the cost of their care,
or helping them avoid foreclosure on their homes.
“I consider my job to be helping alleviate financial disaster for our
cancer patients so they can focus on their care, rather than worrying about their financial problems,” he said.
Americans fear the cost of cancer care as much as they do dying of
the disease, a recent survey by the Community Oncology Alliance
found. Even among insured patients, 20 percent spend their life
savings on cancer care, according to a recent study.
Each day, he reviews records of new patients, looking for those who
need his help. He signs them up for the best insurance he can find,
collaborates with pharmaceutical companies to provide free drugs
($140,000 worth in the first three months of 2011), and refers some
patients to other agencies to help with a range of financial issues.
Based on Rogers’ experience, The Lacks Cancer Center administrators in 2008 approved a pilot program during which Sherman
helped patients overcome a range of financial problems. He now
serves as clinical financial consultant.
Three years after completing her treatment, Jo Ann Rogers is cancer
free and eternally grateful not only for the medical care she received
at Saint Mary’s, but for the financial help Dan Sherman gave her.
No patient ever is turned away from Saint Mary’s for lack of
insurance or the inability to pay, but the program not only eased
the financial worries of countless patients, it helped the hospital
recover some of the cost of charity care. In its first five months,
the pilot program saved Saint Mary’s more than $340,000.
“I wanted to kiss him,” she said, “but I didn’t dare. I think he’s the
greatest thing there is. If I called and told him I needed to talk to
him, he’d be there.”
Had she not gotten his help and the first-rate medical care at Lacks,
she is certain of one thing: “I’d probably be dead.”
AVOIDING FINANCIAL DISASTER: Without insurance, Jo Ann
Rogers was certain she could not afford treatments for leukemia.
Dan Sherman helped her figure out a way she could.
DAN SHERMAN
Clinical Financial Consultant
12
Nurses
NAVIGATING CANCER: Breast cancer patient Hope Ottobre
and her husband, Mike, meet with Nurse Navigator Cheryl
Valentine. At the center, each patient is assigned a nurse
navigator to guide them through treatment.
As a nurse manager at The Lacks Cancer Center, MarKay
Riippa supervises a staff of nurses, each trained in the
specialized care of cancer patients. In the war on cancer, they
are the frontline soldiers. For many, it’s a battle they take
personally.
“I think most of us have been touched by cancer,” Riippa said.
Both her parents died of cancer. “I think all nurses care about
their patients. What makes us special is we understand the
impact of cancer. We have a lot of compassion.”
Each patient who arrives at the center is assigned a nurse
navigator to guide them through their treatment and answer
any questions they have. Center administrators created those
specialized positions because they recognized a diagnosis
of cancer is difficult enough without the additional burden of
maneuvering through treatment on their own.
“I THINK EVERY HOSPITAL WILL TELL
YOU THEY TREAT THE MIND, BODY
AND SPIRIT. WE MAKE IT REAL.”
“That’s our goal, that each patient has someone they can
count on who can guide them from point A to point B,” said
Cheryl Valentine, one of three nurse navigators who guide
breast cancer patients. “If nothing else, I want them to know
‘if I have a question, I can call Chery.’”
After an initial visit, each patient receives a binder containing
a detailed treatment plan — “not just a generic booklet, but a
personalized plan customized for their diagnosis and course
of treatment,” Valentine said.
A cancer resource specialist also is assigned to each patient
to help with the emotional and practical aspects of cancer
care. That includes referring them to support groups, helping
them develop coping strategies and linking them with community organizations that provide transportation, financial
help, housing and other services.
“Our goal is to heal every patient,” Riippa said, adding that
even for those patients who can’t be healed physically, “We
try to bring them hope.”
“These are very complex cases,” she said. “You say ‘cancer,’
and all hope drains out of you and fear takes over. You have to
understand how cancer affects their bodies, what their needs
are. A lot of times, a patient will talk to a nurse when they
won’t talk to family members.”
It takes a special person to give that kind of care.
“You have to have a desire; you have to have a heart. You have
to be a good listener,” Riippa said. “You have to be a person
who can deal with a situation that can be very difficult. I think
every hospital will tell you they treat the mind, body and spirit.
We make it real.”
MARKAY RIIPPA
CHERYL VALENTINE
Nurse Manager
Nurse Navigator
13
Radiation
Judy Benger arrived for her first radiation treatment, happy in the
knowledge she had two different kinds of cancer. Normally, that
would not be good news, but, for Benger, the diagnosis was much
better than her doctors originally had feared.
Initially, they thought she had stage-four breast cancer, greatly
reducing her chances of survival. A mammogram showed a lump
in her left breast, and a CT scan appeared to indicate it had
metastasized, or spread, to a lymph node. After Dr. Bruce
Shabahang removed the lymph node, a pathologist determined
it was chronic lymphocytic leukemia.
“This is the best possible news for this lady,” Shabahang said. “We
were painting a picture of metastatic breast cancer — all gloom
and doom. This is not gloom and doom. Basically, she’s got two
treatable cancers.”
A few weeks later, Dr. Jamie Caughran removed a small cancerous lump from Benger’s left breast. The cancer was detected early
enough, thanks to the mammogram, and the lump was small
enough that she did not need chemotherapy. “A series of radiation
treatments alone would reduce her chances of the breast cancer
recurring to less than 10 percent,” Dr. Mike Wilkinson, a radiation
oncologist, said.
For now, her chronic lymphocytic leukemia, a slow-growing
type common in older adults,
would require no treatment,
only careful monitoring.
A technician positioned
Benger on a table beneath
a linear accelerator, while
Wilkinson studied her CT
images that had been shot
earlier to ensure the machine
focused the radioactive beam
at the area where the tumor
had been removed.
Down the hall, a TomoTherapy® machine combines the high energy
of a linear accelerator with a CT scan, to further ensure the radiation
is focused only on the tumor, not on the healthy tissue. The Lacks
Cancer Center was one of the first 20 TomoTherapy® Centers of
Excellence in the world.
Saint Mary’s two medical physicists — Dr. Tewfik Bichay and Chen
Chen — work with a team of dosimetrists to translate prescriptions
from the radiation oncologists into treatment plans custom made
for each patient.
LATEST TECHNOLOGY: Breast cancer patient
Judy Benger lies under a linear accelerator, while
Dr. Mike Wilkinson, a radiation oncologist, prepares
her for the first in a series of radiation treatments.
14
EXPERT CARE: Medical physicists Dr. Tewfik Bichay and Chen Chen work
with a team of dosimetrists to develop a personalized radiation treatment
plan for each patient. Bichay is the area’s only PhD medical physicist.
“The ultimate intent is to
deliver as much radiation to
your target and as little as
possible to the surrounding
tissue,” Bichay said. “As a
result, complication rates for
patients have gone down
substantially,” he said.
Ironically, the same radiation
that can cure cancer also
can cause it, so to safeguard
from radiation leakage most
radiation oncology rooms
have lead-lined doors, weighing about 3,000 pounds, which are
closed during treatments, leaving the patient alone.
“The patients hated it,” Bichay said. “They’d hear that thud, and they
felt all alone. They felt like they were in a tomb.”
Saint Mary’s was the first hospital to use that patent-approved
design, allowing patients to feel more relaxed. Others hospitals
are following Saint Mary’s lead. “It’s really become the way to go,”
Bichay said.
During her two-minute treatment, Benger was spared the desolate sound of a heavy door closing. She would return the next day
for a second treatment and five days a week for the next month.
After that, her doctors will carefully monitor her for any sign that
the breast cancer has returned or that the chronic lymphocytic
leukemia has progressed to a stage that requires treatment.
Benger was beyond relieved when told she doesn’t have stage-four
breast cancer, and she’s thankful her gynecologist referred her to
The Lacks Cancer Center.
“I couldn’t have asked for a better place than Saint Mary’s,” she said.
“The nurses, the doctors, everybody was so friendly. I was overwhelmed by it. I think they’re really great people here.”
That’s why Bichay designed the four radiation oncology rooms at
The Lacks Cancer Center without the thick leaden doors. The hallways leading into the rooms have walls set at angles to deflect the
radiation, which is absorbed by a plastic lining beneath the drywall.
PRECISE PLANNING: Dr. Bruce Shabahang studies
images of a suspected tumor in a lymph node before
operating on Judy Benger.
GRATEFUL PATIENT:
Patient Judy Benger was
relieved to hear that her
breast cancer was detected
at an early stage.
15
Research
As better treatments for cancer are discovered, chances are
they’ll be studied here first, in Saint Mary’s Health Care’s new
clinical trial unit.
The unit, the only one of its kind in the Grand Rapids area,
opened last year, allowing researchers to conduct Phase I
trials here. For West Michigan patients, that means they will
have quicker access to the latest and most effective therapies.
“It’s a significant investment, but we believe it’s the right thing
to do,” Susan Hoppough, Saint Mary’s director of research and
innovation, said as she walked through the new unit. “We’re
committed to offering the latest technology and treatments to
the patients we serve. It’s part of our mission.”
For years, Saint Mary’s has participated in Phase II and
Phase III clinical trials. The new unit allows doctors and other
researchers to conduct Phase I clinical trials — the first stage
during which new drugs and other treatments are tested on
small numbers of volunteer patients. Drugs cleared in Phase I
go on for further testing on larger numbers of patients in
Phase II and Phase III trials.
In the past, West Michigan patients who wanted to participate
in early clinical trials had to travel elsewhere.
“We’re interested in bringing the best in clinical trials to our
patients,” Hoppough said. “They won’t have to travel far away.
We’re bringing the research to them.”
“WE’RE BRINGING THE RESEARCH TO THEM.”
The eight-bed unit is available not only for Saint Mary’s doctors
to perform studies, but for other community researchers,
including those at universities and pharmaceutical companies.
The new unit will be used to test new treatments against
neurological diseases, HIV/AIDS, diabetes, kidney diseases
and mental illness, as well as cancer.
The Lacks Cancer Center doctors are deeply involved in other
forms of research aimed at finding the best treatments. Dr.
Laurence McCahill, director of surgical oncology at the center,
recently completed a study that found wide variability in how
breast cancer patients are treated at different hospitals. Nearly
a quarter of the 2,200 patients who had partial mastectomies
underwent a second operation, the study found, but surgeons
and hospitals differed greatly on how they determined the
follow-up surgery was necessary. McCahill hopes the study,
published in the Journal of the American Medical Association,
leads to uniform standards for treating breast cancer.
Doctors at Saint Mary’s also are involved in studies with the
Van Andel Institute, a medical research facility a few blocks
away. That includes sending tumor samples to the institute for
16
research into the genetic origins of various kinds of cancers.
Unraveling the genetic mutations that cause cancer is a highly
complex endeavor, but, ultimately, it should lead to better
treatments and possibly cures.
Michigan State University’s decision to move the headquarters
of its College of Human Medicine to Grand Rapids also expands
the opportunities for doctors and patients here to participate in
the latest research.
Taken together, the various efforts to increase research
“means our patients will have access to the cutting edge
clinical trials, and West Michigan patients will be contributing to the new standard of care,” said Dr. Gilbert Padula, a
radiation oncologist at the center and associate principal
investigator for the Grand Rapids Clinical Oncology Program.
The program is a cooperative effort of doctors and hospitals in
West Michigan and Traverse City with direct funding from the
National Cancer Institute (NCI) to “provide top-notch cancer
care close to home,” said Padula, who in 2012 will become
principal investigator overseeing the program’s clinical trials.
Most advances in cancer care, he said, come in small increments rather than big breakthroughs.
“I think it will be a series of steps that will turn cancer into
a chronic disease,” Padula said. “We’re making strides
every day.”
CUTTING-EDGE CARE:
The clinical trial unit,
which opened in 2011,
will allow Saint Mary’s to
increase its research and
offer patients the latest
treatments.
To keep up with an increasing need for its services, The Lacks
Cancer Center continues adding physicians and other staff
members. In August 2011, Dr. Jessica Keto and Dr. Ebony
Rashaan Hoskins, both attracted by the center’s comprehensive
approach to cancer care, joined the staff.
EBONY HOSKINS, MD
EXPANDING RESEARCH: Brian Berryhill
During a fellowship with
the National Cancer Institute, Dr. Ebony Rashaan
Hoskins conducted
extensive research and
published many papers
on ovarian cancer.
(left), clinical research pharmacist; Lynn
Cherney, clinical research coordinator;
Michelle Rae, clinical research assistant;
Kyle Herrington, finance analyst; and
Susan Hoppough (right), Saint Mary’s
director of research and innovation,
tour the new clinical trial unit.
In August, she brought
that knowledge to The
Lacks Cancer Center as
its newest gynecologic
oncologist. Hoskins, who earned her medical degree from Wayne
State University, works closely with Dr. Kevin Brader, director
of gynecologic oncology. Before joining the staff, Hoskins completed a residency in obstetrics and gynecology at St. Joseph
Mercy Hospital near Ann Arbor and a fellowship in gynecologic
oncology at Magee Women’s Hospital in Pittsburgh.
As a surgeon, she appreciates The Lacks Cancer Center’s approach
to “treating the whole person and the family,” she said.
JESSICA KETO, MD
GILBERT PADULA, MD
Radiation Oncologist
Associate Principal Investigator, Grand Rapids
Clinical Oncology Program
After graduating from the
Michigan State University College of Human
Medicine and during
her surgical residency in
Grand Rapids, Jessica
Keto became familiar
with the Comprehensive
Breast Center in The
Lacks Cancer Center at
Saint Mary’s.
In August, after completing a fellowship in breast surgery at
Israel/St. Luke’s Roosevelt hospital in New York, she returned
to The Lacks Cancer Center as associate medical director of the
Comprehensive Breast Center, where she works closely with
Dr. Jamie Caughran, the medical director who created the
Comprehensive Breast Center.
“I had experience with Saint Mary’s, so I knew they are dedicated
to patient care,” Keto said. “I was very excited to come back.”
17
Urology
After Ty Wessell was diagnosed with prostate cancer, some
doctors urged him to undergo radiation therapy.
Initially, he was convinced that was his best option, but “then
I thought I ought to talk to a surgeon,” Wessell said.
As a former school principal in East Grand Rapids and Rockford,
he was familiar with Saint Mary’s Health Care and vaguely
aware of The Lacks Cancer Center. But the center was more
than 170 miles from his home in Northport, where he recently
had retired as the school superintendent.
After researching the reputations of various cancer centers,
“My wife and I said we were going to go where we felt most
comfortable,” Wessell said.
He made an appointment with Dr. Paul Rodriguez, a urologist
at The Lacks Cancer Center and one of West Michigan’s most
experienced surgeons specialized in treating prostate cancer
and other urinary disorders.
“He was the first doctor I had talked to since my diagnosis
who talked to me about options, rather than telling me what
I ought to do,” Wessell said. “What a rare experience. He had
all the time in the world. He obviously knew the research.”
“WHAT A RARE EXPERIENCE. HE HAD
ALL THE TIME IN THE WORLD.”
Wessell decided to undergo surgery at The Lacks Cancer
Center, despite the distance from his home. On August 8,
2011, Rodriguez performed the surgery with one of Saint
Mary’s da Vinci robots. A couple of days later, Wessell was
home. A month later, he was able to resume running two
miles a day.
INSTILLING CONFIDENCE: Although
he lives 170 miles from Grand Rapids,
Ty Wessell chose to have his prostate
surgery at The Lacks Cancer Center.
“My wife and I said we were going to
go where we felt most comfortable,”
he said.
18
“Never felt better,” he said less than two months after his
surgery. “I’m a real fan of Lacks.” During his brief stay, “I felt
like I was in a hotel.”
Mike Schaper could have told him that. As a prostate cancer
survivor, he has urged others to consider having surgery
performed by Rodriguez at The Lacks Cancer Center. He was
45 when his prostate cancer was diagnosed four and a half
years ago.
“Dr. Rodriguez is a wonderful man,” Schaper said. “He was so
open with me.”
He decided to have Rodriguez perform surgery with the
da Vinci, which is far less traumatic, results in less blood loss
and allows quicker recovery than with traditional surgery.
As he was wheeled into the operating room, “I remember
looking at it (the robot) and thinking, how cool. How’s that
going to work? To me, it’s amazing that they can do that.”
After his discharge, “I felt great,” Schaper said, adding he
needed no pain medication. “My wife thinks I have a high pain
tolerance. I think I’m a wimp when it comes to pain. I wouldn’t
want to have it again, but to me it was a cake walk.”
Four and a half years after his surgery, he remains cancer free.
For Schaper and Wessell, their futures are bright because their
cancers were detected early — “a key for surviving most
cancers, including of the prostate, the most common form
for men,” Rodriguez said. One out of six men eventually will
develop prostate cancer, the second leading cause of cancer
death for men.
“Right now in my practice, we’re seeing men with early stage prostate cancer for whom survival is 95 percent or better,” Rodriguez said.
Early diagnosis and the advent of the PSA (prostate-specific
antigen) test have improved survival rates, he said. Some doctors
recommend annual testing for men over 50. For those at a high
risk for prostate cancer, including African American men and those
with a family history of prostate cancer, the test is recommended
beginning at age 45.
Since he began using the da Vinci in 2006, Rodriguez has performed the robotic surgery on nearly 500 prostate cancer patients.
As an independent physician, he could perform surgery at other
hospitals, but 90 percent of his practice is at Lacks.
PAUL RODRIGUEZ, MD
Urologist
“It’s a nicer place to be for the patients and the doctors,” he said.
“We have access to all the latest technology. We have highly trained
physicians and nurses in a setting that is conducive to the health
and wellbeing of the patient.”
RELAXING AT HOME: Mike Schaper’s wife,
Jane, thinks he has a high pain tolerance.
He disagrees. The da Vinci surgery, he said,
made it “a cake walk.”
QUICK RECOVERY: Prostate cancer patient Mike
Schaper was able to resume work and play shortly
after undergoing robotic surgery.
19
Palliative Care
The patient has cancer, recently had a leg amputated and now, due
to a head injury, is partially paralyzed. He made it clear he does not
want extraordinary measures to keep him alive.
Understandably, his family is upset, but they support his decision.
“Do they understand what the other alternatives are?” asked Dr.
Emily Gualtieri. “I suspect what they want is to see the patient
well cared for.” As the medical director of Saint Mary’s critical care
unit, Gualtieri is a member of the hospital’s palliative care team
that meets to discuss cases and give patients and their families
the information they need to make informed decisions.
As in all cases, this patient and his family members were told in
layman’s terms the likely course of his many illnesses and possible
treatments. “The patient made it clear he does not want to be
placed on a ventilator, which would help him breathe,” Dr. Richard
Chambers said during a meeting of the palliative care team.
“There are times when you have a recovery better than what you
think,” he said, but, for this patient, the “prognosis is very grave.
He could go quickly, or he could linger. We’ll make sure he’s
comfortable.”
“I think it’s empowering to have information that’s not just in medical
terms, but to really understand what’s coming next,” Dr. Colleen
Tallen, medical director of palliative care at Saint Mary’s, said. “I’m
part of the team that listens to patients. Tell me about your life.
Tell me what’s important to you. Do they really understand their
disease? We want them to understand what their choices are. We
help patients make decisions that they want, not what I want.”
A visit from a palliative care specialist does not mean a patient is
considered to be terminally ill. About 70 percent of the patients
the team helps are not sick enough to be eligible for hospice care.
Many will recover. Some cancers and other diseases that once
were considered universally fatal now, if not curable, can be treated as chronic conditions. The palliative care team helps patients
deal with the discomfort of their diseases and the side effects of
treatments, including pain and nausea.
“We try to proactively prepare patients and anticipate problems
before they happen,” Tallen said. “We can walk with these patients
and help prepare them for whatever decisions might come, and,
when it’s time to make those decisions, we can be there.”
The palliative care team — including three doctors, three nurse
practitioners, a physician assistant, two nurses and a chaplain —
consider the medical, ethical and personal issues involved in each
case. Members of the team meet with patients and their families
to discuss the likely courses of their diseases and possible treatments. Ultimately, it is the patient and the family, not the physician,
who decide what to do.
COLLEEN TALLEN, MD
Medical Director of Palliative Care
EASING DISCOMFORT: Members of Saint Mary’s
palliative care team, including Dr. Emily Gualtieri
(left), Dr. Colleen Tallen (second from left), medical
director of palliative care, and Clinical Nurse Leader
Laurie Sayer meet regularly to help patients deal
with the discomfort of their diseases.
20
WEAVING WARMTH: Retired
nurses (left to right), Nan Jager,
Nancy Sweetnam, Wilma Courson
and Mary Kay Kampfschulte,
meet weekly at The Lacks Cancer
Center to knit prayer shawls for
the patients.
Mercy Knitters
For most of the Mercy Knitters, their weekly gathering at
The Lacks Cancer Center is a homecoming.
“We all feel connected to Saint Mary’s,” Mary Ann Finn said.
That connection is spiritual, as well as tangible, because The
Lacks Cancer Center was built on the site of the original hospital building where many of the Mercy Knitters were trained as
nurses. The Mercy Central School of Nursing, based at Saint
Mary’s, opened in 1898 and graduated its last class in 1986.
When the center opened in 2005, two of the nursing school’s
graduates, Kay Paskiewicz and Nancy Sweetnam, asked if
they could provide prayer shawls for the cancer patients. Not
only did Saint Mary’s accept the offer, but asked the women
and their friends to knit once a week on the center’s fifth floor,
a light-filled area where many patients come to relax. That’s
when Mercy Knitters was born.
“NOT ONLY ARE WE GIVING, WE’RE
GETTING BACK AS WE GIVE.”
The women say a prayer for each shawl: “Creator God, Bless
this yarn and these needles. May this shawl be a sign of your
healing presence. May it warm those who are weary, surround
those who suffer and encircle those who are in pain. May Your
gentle touch reach out to heal in the light of Christ. Amen.”
The women complete about 200 shawls a year and give them
to the patients. They do it for the same reason that prompted
them to become nurses — “for the love of helping others,”
Nan Jager said.
“Not only are we giving,” added Nancy Sweetnam, “we’re
getting back as we give.”
HOMECOMING: The Lacks Cancer Center was built
on the site of the original hospital, where many of
the Mercy Knitters, including Mary Ann Finn (left)
and Jacque Heynen, studied nursing.
A dozen of the women, most of them retired nurses, sat in
a circle next to the fifth floor’s conservatory one morning.
While they do most of their crocheting and knitting at home,
their weekly visits to The Lacks Cancer Center keep them
connected with the patients.
“A lot of us have had cancer, so we know how it feels,” Wilma
Courson said.
21
Therapy Dogs
Charley and Frisco are trained therapists. They arrive at The Lacks
Cancer Center for their weekly rounds one morning and immediately are greeted by staff members and patients. They’ve come to
comfort the sick.
Patients perk up when Charley and Frisco arrive. Many miss their
own dogs, and these weekly visits keep them connected with the
world beyond the hospital’s walls. “There’s a connection beyond
words with dogs,” MarKay Riippa, a nurse manager said.
They work without compensation, save for the occasional biscuit.
Charley and Frisco, a pair of golden retrievers, are among the many
volunteers who keep The Lacks Cancer Center running smoothly
and make life more pleasant for the patients and staff.
The dogs possess an intuitive sense of which patients and their
families most need them, Muth said. “I don’t know how to say this
any other way,” she said. “It’s spiritual.”
“Hello there. You’re so sweet,” patient Nancy Eldred said, petting
Frisco’s head. “It puts a smile on your face. I felt like he was pouring
healing into me.”
One day, while walking the halls at Lacks, she and Frisco came upon
a woman sitting outside a room where her father was dying.
“I just asked God to send me an angel,” the woman said, “and he
sent me a four-legged one.”
The dogs and their owners, Myra Muth and Shari Duthler, are
volunteers and members of the nonprofit West Michigan Therapy
Dogs Inc. To call the women the dogs’ handlers is a misnomer,
considering that Frisco and Charley each completed a seven-week
course that included training in such hospital protocol as avoiding
IV lines.
“I got into it because both my parents died of cancer, and they were
helped by therapy dogs,” Muth said.
Duthler said her family also has dealt with cancer. “I thought, what
can I do to give back to the community?” she said. The answer was
to bring patients a little comfort that only a gentle pet can provide.
REMINDERS OF HOME: Patient Marcy Deur and her
husband, Butch, pet Charley. For many patients, the
therapy dogs bring a sense of normality.
CARING CANINES: Therapy dogs Frisco (left) and
Charley, with their handlers, Myra Muth (left) and Shari
Duthler, comfort Saint Mary’s patients every week.
22
Food
The sun is shining, and, in a courtyard at Saint Mary’s Health
Care, chicken and corn on the cob are sizzling on the grill. The
aroma draws patients, visitors and staff members, who line
up for lunch.
This is hospital food? The kitchen crew at Saint Mary’s is changing the perception that hospital food by definition is bland.
The hospital’s macadamia nut-encrusted tilapia recently won
a hospital chefs’ competition in Chicago, and its other menu
offerings have taken top honors in competition against mainstream restaurants, not just hospital cafeterias.
“THE FOOD HERE WAS EXCEPTIONAL,
LIKE A FIVE-STAR RESTAURANT.”
In the past, hospital patients, if they were lucky, had two
choices for each meal and no choice of when it was served.
When The Lacks Cancer Center opened in 2005, it offered
room service, which since has been phased in throughout
Saint Mary’s Health Care. Patients can order breakfast from
7 a.m. to 7 p.m. and lunch and dinner from 11 a.m. to 7 p.m.
Guests also can order from the room service menu or dine in
the hospital cafeteria. Those patients on restricted diets are
offered special menus.
For most patients, the choices are considerably wider than
in the past, much like you’d see in a popular restaurant, with
such entrees as grilled Atlantic salmon, as well as a variety of
sandwiches and pasta dishes. Specials, such as sea bass and
short ribs, are offered each day.
HOSPITAL FOOD? The Lacks Cancer Center patients are able to order from
an extensive menu, featuring entrees, such as grilled Atlantic salmon with
sautéed vegetables, a fresh garden salad and an apple.
“The food here was exceptional, like a five-star restaurant,”
said Amy Johnson, a former Lacks patient.
Every Thursday throughout the summer, kitchen staff members
cook outside on a gas grill. This year, they planted a garden in
the courtyard, so the staff can cook with homegrown peppers,
cabbage, tomatoes and herbs.
ROOM SERVICE: Food service
employee Trang Nguyen
delivers a meal to patient
Tammy VanVolkinburg.
23
Library and Chapel
At The Lacks Cancer Center, patients and their families can find
information and inspiration.
A woman walked into the center’s Warren Reynolds Library one
afternoon. Typical of many who come here, she recently had
received troubling news and was seeking answers.
“How can I help you?” Brett Powers asked. It’s more than a greeting.
Powers is the center’s medical librarian with many years of experience helping cancer patients, their families and others find reliable
information about cancer.
Her husband recently was diagnosed with a brain tumor, the woman
said. Powers led her to the library’s shelves filled with books, pamphlets, DVDs and CDs and pointed out those most relevant to her
husband’s diagnosis. She left with a handful of pamphlets. Chances
are she’ll be back.
“It’s very common for them to get basic information and then come
back looking for more,” Powers said.
The woman had come to the one place that could provide the
information she was seeking, one of the five largest cancer center
libraries in the country and the most comprehensive in Michigan.
The library was inspired by the late Warren Reynolds, a longtime
Grand Rapids sports broadcaster who died of cancer in July 2000.
Reynolds had expressed frustration at his inability to find information
about the kind of cancer he was battling, so his family and friends
raised money to open and support the library in his name.
Saint Mary’s Health Care recruited Powers, previously a medical
librarian at the MD Anderson Cancer Center in Houston and the
Wright State University medical school in Dayton. He and Susan
Hoppough, Saint Mary’s director of research and innovation, visited
cancer center libraries around the country to gather ideas for how
the Warren Reynolds Library should be designed.
Since it opened on the center’s second floor in January 2005, the
library has provided information to more than 22,000 visitors.
“Anybody who walks through the door can use the library,” whether
they are Lacks patients or not, Powers said. “Patients have lots of
questions that they can’t always get answered,” so they come into
the library. For some, their diagnosis is so new, they don’t know
what to ask. “This information helps them ask better questions,”
Powers said.
PROVIDING INFORMATION: Andrew Spoolstra and Physician Assistant
Rick Malmsten look up information in The Lacks Cancer Center’s
Warren Reynolds Library, the only cancer library in West Michigan.
24
FINDING FAITH: Fr. Ayub Francis Nasar,
a Saint Mary’s chaplain, leads mass in
The Lacks Cancer Center’s chapel. Those
The Warren Reynolds Library includes a reading room, private
study rooms, six desktop computers and 15 laptop computers that
patients can check out, as well as iPods loaded with 1,000 songs,
“whatever we can do to make their stay easier,” Powers said.
That includes a business center with faxing, copying, mailing and
notary services. The library shelves are filled with more than 1,000
books on cancer, as well as pamphlets, DVDs, CDs and other
reference materials.
patients unable to attend can view the
service on closed-circuit television.
Those materials include not only medical information about the many
forms of cancer, but help for family members, as well as advice on
the nutritional, financial and spiritual aspects of the disease.
Those who can’t get answers to all their questions in the library often
find them just down the hall in The Lacks Cancer Center’s chapel,
where Fr. Ayub Francis Nasar, a Saint Mary’s chaplain, was about to
hold mass.
After Sister Marie Joy Yuhasz played “For the Beauty of the Earth,”
Nasar walked to the pulpit and, addressing those in the chapel and
patients watching on closed-circuit television, began “this mass that
God may heal them. May the Almighty God have mercy upon us,”
he prayed.
It’s all in keeping with the Saint Mary’s pledge to treat not only the
disease, but the patient’s mind, body and spirit.
BRETT POWERS
Librarian
25
A LETTER FROM
PHIL McCORKLE
No one wants to hear they have cancer. Our goal from
Last year, we opened a new Phase I Clinical Trial Unit,
the moment a patient arrives at The Lacks Cancer Center
which will allow us to expand our research into cancer
is not only to treat the disease, but to make the
and other diseases and give our patients access to the
experience as easy as possible for the patient and the
most progressive treatments.
family during a very difficult time. Our oncologists and
surgeons are nationally recognized for their expertise,
The depth and breadth of our cancer program has grown
and we provide them with the latest technology,
rapidly since we opened The Lacks Cancer Center six
including a Radiation Oncology Department.
years ago, and we plan to continue growing to meet the
needs of our patients and families. They have the right to
But that’s not enough. We take a multi-disciplinary
expect the best care available anywhere and the peace
approach to treating cancer, and always keep it centered
of mind of knowing they can get it close to home.
on the patient. Our physicians are supported by a staff of
nurses, physician assistants, social workers and others
dedicated to giving the best care with compassion,
Sincerely,
considering every aspect of each patient’s life — mind,
body and spirit. Our Comprehensive Breast Center is the
only place in West Michigan that offers Mammo-Plus®,
combining an advanced mammogram with a program
Phil McCorkle
that allows our patients to assess their lifetime risk for
President and CEO
developing breast cancer.
Saint Mary’s Health Care
The Lacks Cancer Center is West Michigan’s only dedicated, inpatient cancer facility. It also is one of only
30 in the country, and the only one in West Michigan,
recognized by the National Cancer Institute as a National
Community Cancer Center Program. That prestigious
selection allows us and the other 29 hospitals to share
information on the most advanced treatments available.
26
27
HOW A MULTIDISCIPLINARY CLINIC
HELPS GASTROINTESTINAL CANCER PATIENTS
GET BETTER, FASTER CARE AT LACKS
Compiled by Larry McCahill, MD
Medical Director, Surgical Oncology
Assistant Director, The Lacks Cancer Center
Director, Lacks Gastrointestinal Multidisciplinary Program
Initial research strongly supports that offering care through the GI
Imagine a hospital where patients with newly diagnosed gastroin-
The GI MDC began seeing patients in January 2010 and has collected
testinal cancer can begin treatment sooner — with access to a nurse
data to ensure that quality is both optimal and continuously improv-
dedicated to helping them navigate their way through a complex care
ing. This report summarizes the goals and key findings of the GI MDC.
MDC may also provide a more patient-centric experience — assuring
that care is timely, coordinated and well communicated between the
patient and the entire treatment team.
plan with open, ongoing communication between their physician and
the entire care team.
GOALS OF THE GI MDC MEASURED IN THIS REPORT:
In addition, patients could see all their specialists, including surgical
• Provide a patient-centric experience in which physicians and health
care staff come to the patient in a single clinic visit.
oncologist, medical oncologist, radiation oncologist, dietitians and
social workers in one appointment, at one location.
• Assure that cancer care for each patient is:
-timely,
THIS IS THE GASTROINTESTINAL MULTIDISCIPLINARY CLINIC
AT THE LACKS CANCER CENTER AT SAINT MARY’S.
-coordinated,
- and well-communicated to the patient and all members
of the treatment team.
Traditionally, it can take several weeks or even months to gather all
necessary clinical information and medical consultations before treat-
• Assure that both staging studies and clinical treatment are concor-
ment can begin. This is particularly true if physician visits and diagnos-
dant with evidence-based cancer practice guidelines, as currently
tic testing are done serially, which also contributes to communication
published by the National Comprehensive Cancer Network (NCCN).
breakdown of vital information and treatment planning. As a result,
many patients diagnosed with gastrointestinal cancer experience a
long time gap between diagnosis and initial treatment.
GI MDC PROGRAM QUALITY MEASURES:
• All patients diagnosed with GI cancer are evaluated by their entire
medical team in one visit.
To help shorten this lag time, a Gastrointestinal Multidisciplinary Clinic
(GI MDC) dedicated to gastrointestinal cancers was implemented in
• Patients are contacted within two days of referral, and communi-
January 2010 and GI Nurse Navigator, Coralyn Martinez, MSN, RN,
cation to referring and primary care physicians with the patient’s
OCN, was hired to focus on GI cancer patients and their care. The
scheduling plan is completed within two days.
purpose was three-fold:
1. Increase the likelihood of evidence-based treatment.
• Patient’s cancer stage is established within five days of referral.
• Patients are evaluated within 10 calendar days of referral and have
2. Improve communication among the treatment team.
3. Increase positive patient experience in their cancer journey through
a clear treatment plan at the end of their clinic visit.
• Patients are offered appropriate treatment in accordance with
enhanced coordination of all medical services.
NCCN guidelines regarding all three disciplines: Medical Oncology,
Radiation Oncology and Surgery.
What is a Gastrointestinal (GI) Nurse Navigator?
Team
A dedicated GI nurse navigator is a registered nurse with specific training in GI
GI MDC Physician Leader: Larry McCahill, MD,
cancer. These cancers include colorectal, pancreatic, esophageal and gastric
FACS-Surgical Oncologist
cancers. In addition, GI cancer can also encompass the hepatobiliary system, such
GI Nurse Navigator: Coralyn Martinez, MSN, RN, OCN
as liver, bile duct and gall bladder cancers. This nurse is oncology certified and
Quality Specialist and Auditor: Mary May, MS, RN
works closely with the patient to coordinate efficient care with multiple specialists.
Program Analyst: Wendy Taylor
The nurse navigator serves as the primary contact between patients and
specialists and works to maximize treatment outcomes and patient satisfaction.
With special thanks to all members of the steering committee,
and participation of all physicians, nurses, research staff and
ancillary staff participating in the GI MDC Program.
28
Special Focus: Pancreatic Cancer
GI Nurse Navigator at The Lacks Cancer
Center at Saint Mary’s is GI Nurse
Navigator of the Year
While a GI Nurse Navigator coordinates care
for all patients diagnosed with GI cancer,
this section highlights pancreatic cancer,
Coralyn Martinez, MSN, RN, OCN, of The Lacks
the #1 diagnosis in The Lacks Cancer Center
Cancer Center of Saint Mary’s, was recently named
GI MDC. Nearly 40 patients with pancreatic
the National GI (gastrointestinal) Navigator of the
cancer were seen at The Lacks Cancer Center
year by the Academy of Nurse Navigators at its 2011
in 2010 and 64 have been seen YTD 2011.
conference in San Antonio, Texas.
KEY FINDINGS:
Average Length of Stay in the Hospital After Surgery (Fig. 1.4)
• The GI MDC consistently meets or exceeds its goals, with very
• National Average: 16.5 days
few exceptions.
• The Lacks Cancer Center: 11 days
• Patients are now contacted by the GI Nurse Navigator generally
• Staging evaluations are almost uniformly completed within five
business days of referral.
• The time between referral and when cancer treatment begins
averages 15 days in 2011, down from 22 days in 2010. (Fig. 1.1)
Days
Fig. 1.1
Average Calendar
Days from Referral
to Cancer Treatment
Initiation
25
20
15
10
5
0
Goal is 25
calendar days
22.3
17.1
Q1
2011
14.5
15.0
13.9
Fig. 1.4
The Lacks Cancer
Center Median
Length of Stay
15
Days
the same day as referral.
10
Mean Hospital LOS
Benchmark: 13.7–16.5
days (Johns Hopkins
University and National
Inpatient Sample)
16.5
11.0
13.7
5
0
The Lacks
Johns
Cancer
Hopkins
Center 2010 University
1984–1999
National
Inpatient
Sample
1996–2006
Key Findings
Average Operation Time
Q2
Q3 2010 YTD
2011 2011
2011
Quality Measures: Timeliness, Efficiency of Health Care Delivery
• Cancer staging studies are more than 90% compliant with NCCN
staging guidelines.
• Physician clinical evaluations are completed within less than ten
(10) days of referral, with a 2011 average of 6 days. (Fig. 1.2)
Benchmark
324–400 minutes*
Goal
Less than 600 minutes
414 minutes
Median Estimated Blood Loss During Surgery
Benchmark
750–1200 ml*
700 ml
Percent of Intra-operative Blood Transfusions
Goal is 10
calendar days
10
Days
Fig. 1.2
Average Calendar
Days Until Patient
is Seen in
GI MDC Clinic
5
6.5
5.0
6.4
7.3
Benchmark35%**
6.0
28%
*Indiana University and Johns Hopkins University **Johns Hopkins University
0
Q1
2011
Q2
Q3 2010 YTD
2011 2011
2011
Quality Measures: Timeliness, Efficiency of Health Care Delivery
QUALITY AND CONTINUOUS IMPROVEMENT
• The GI MDC continues to meet its goal of having patients seen by
Fig. 1.3
Patients Seen by all
Required Physicians
at First Clinic Visit
Percent
all necessary physicians in one clinical visit. (Fig. 1.3)
100
80
60
40
20
0
The clinic has worked closely with the recommendations of a National
Institute of Health Expert panel statement to incorporate the 41
recommendations for centers conducting pancreatic surgery. Currently,
83
Q1
2011
83
94
93
87
Goal was
70% in 2010;
80% in 2011
The Lacks Cancer Center meets all 41 recommended process, structure
and quality measures.
Q2
Q3 2010 YTD
2011 2011
2011
Quality Measures: Patient Centeredness, Efficiency
29
THE COMPREHENSIVE BREAST CENTER:
REDUCING RISK, SAVING LIVES
The Comprehensive Breast Center at The Lacks Cancer Center opened
offered an appointment in three days or less, often with same-day
its doors in 2011. The only facility in West Michigan of its kind, the
access (Fig. 1.2). Patients with a new diagnosis of breast cancer
Comprehensive Breast Center brings the entire scope of breast care
are scheduled with our fellowship-trained breast surgeons in five
under one roof.
business days or less.
A multidisciplinary approach within one dedicated cancer center
greatly enhances the patient’s experience from initial diagnosis of
breast cancer or disease through recovery and ongoing care.
3.Second Opinion Clinic. For women newly diagnosed or with
recurring breast cancer, this is the opportunity to meet with our
surgeons to ensure awareness of all the treatment options available.
It’s a thorough diagnosis and treatment plan from the entire breast
And as one of 30 hospitals nationwide — and the only in West
cancer team, including breast surgeons, oncologists, radiation
Michigan — recognized as an NCI Community Cancer Centers (NCCCP)
therapists and subspecialists. It includes a consultative review of
Program, we are working within a network of hospitals across the
your mammography findings and/or pathology slides, followed by
country to reduce health care disparities, improve access to clinical
a personalized treatment recommendation developed by our team
trials, improve overall quality of care, and link with national computer
of specialists.
networks that support research. The centers also work to improve
survivorship, palliative care and patient advocacy while allowing
patients to experience exceptional care close to home.
At the Comprehensive Breast Center, the medical staff is dedicated to
being the best in the region. In the past year, the center has received
three national accreditations that recognize achievement in reaching
4.Swift recovery. At the Comprehensive Breast Center, 100 percent
of the breast biopsies are minimally invasive (Fig. 1.3), compared to
a national average of 85 percent. We focus on breast conservation,
which provides the least invasive surgery when possible (Fig 1.4).
In 2010, there were no unplanned overnight stays for those patients
having less invasive surgery such as lumpectomy.
the highest standards in:
An average of three percent of women who receive a MammoPlus®
• Timeliness of care
mammogram — the Comprehensive Breast Center’s exclusive
• Quality of all breast imaging
• Outstanding programmatic components which patients may access
WHY IT MATTERS
With these national achievements and the expert and compassionate
delivery of care, patients have peace of mind knowing that they are
in the best possible place. Specifically, this means that patients have
access to:
1.Experience. Patients of the Comprehensive Breast Center at Lacks
mammogram service that includes digital mammography and a risk
assessment to determine a woman’s risk for developing breast cancer
— prove to be at high risk for developing breast cancer. These patients
are offered access to our High-Risk Clinic, where patients receive
extensive evaluation, counseling and a custom surveillance plan to
reduce risk.
To decrease the barriers for underserved and underinsured women,
the Comprehensive Breast Center has been the recipient of two grants
from The Susan G. Komen for the Cure – West Michigan affiliate.
These grants help underinsured and underserved women receive the
have access to two fellowship-trained breast surgeons — surgeons
care every woman needs. Along with grant funding, the center has
with additional, specific training in breast surgery and breast cancer
provided screening for women through the Breast and Cervical Cancer
care unmatched by anyone else in the region.
Control program for more than 16 years at no cost to the patient.
2.Timeliness with a focus on the patient. Leading the region, the
average time from initial screening to diagnostic mammogram is 3.5
Thousands of women have been screened and provided with access to
all programs offered at the Center.
days (Fig. 1.1). Plus, patients requiring minimally invasive biopsy are
Screening Mammogram vs. Diagnostic Mammogram: What’s the Difference?
30
A screening mammogram is an X-ray to screen women who are at
cancer, a more in-depth diagnostic mammography is done utilizing
risk of developing breast cancer, but have no symptoms. Women 40
more views of the breast from various angles. The mammography
and older are recommended to get a screening mammogram once a
technologist may magnify a suspicious area to produce a detailed
year. If a screening mammogram reveals signs or symptoms of breast
image that can help the physician make an accurate diagnosis.
What is a Breast Nurse Navigator?
This dedicated nurse navigator is a registered nurse with specific
certified nurse for breast cancer treatment navigation, and 2) Breast
training in breast health and breast cancer. She is oncology certified
Health Navigation for breast imaging, callback navigation, navigation
and serves as the primary contact between patients and specialists,
from diagnostic imaging to biopsy, benign disease navigation and
working to maximize treatment outcomes and patient satisfaction.
navigation from MammoPlus® to Risk Analysis. Breast Health Navigation includes nurses and other medical professionals with imaging/
At the Comprehensive Breast Center, we believe that navigation has
diagnostic/high risk experience.
two essential levels of complexity: 1) Nurse Navigation by an oncology
Fig. 1.1
Average Days Between Screening Mammogram and
Diagnostic Mammogram
Fig. 1.4
Breast Conservation Surgery Rate for Eligible Patients
102
100
20
15
96
10
3.5
5
0
National
Average
Comprehensive
Breast Center
at The Lacks
Cancer Center
Fig. 1.2
Average Days Between Diagnostic Mammogram and
Needle/Core Biopsy
Days
20
19
10
5
3
0
National
Average
Comprehensive
Breast Center
at The Lacks
Cancer Center
Fig. 1.3
Percent of Patients Who Received a Needle/Core Biopsy
Rather Than Open Biopsy
120
Percent
100
100 (actual)
80
60
40
94
92
90
88
90
86
84
National
Average
Comprehensive
Breast Center
at The Lacks
Cancer Center
WE BELIEVE THAT NURSE NAVIGATION HAS TWO
ESSENTIAL LEVELS OF COMPLEXITY:
25
15
100 (actual)
98
20
Percent
Days
25
50
Nurse Navigation —
usually a nurse with
oncology experience
Breast
Cancer
Treatment
Navigation
Breast Imaging
Callback Navigation,
Navigation from Diagnostic
Imaging to Biopsy, Benign
Disease Navigation and Navigation
from MammoPlus to Risk Analysis
Breast Health Navigation —
nurses or medical professionals with
imaging/diagnostic/high risk experience
20
0
National
Average
Comprehensive
Breast Center
at The Lacks
Cancer Center
31
250 Cherry Street
Grand Rapids, MI 49503
1.877.LACKSMI (522.5764)
www.lackscancercenter.org

Complete Cancer Care - Mercy Health Saint Mary`s

Transcription

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