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CANCER PROGRAM ANNUAL REPORT 2015 U T I L I Z I N G 2 0 1 4 C A N C E R D ATA Eisenhower Medical Center’s Cancer Program Physicians and Specialists 0 (Blank inside front cover) EISENHOWER MEDICAL CENTER Eisenhower Cancer Program Annual Report 2015 Utilizing 2014 Data Table of Contents Cancer Committee Members .................................................................. 2 Cancer Center Welcomes New Chief Administrative Officer .................. 3 Focus Cancer Site: Acute Myeloid Leukemia Overview and Management ............................................................ 4 Adult Acute Myeloid Leukemia ........................................................ 8 Patient Advisory Committee ............................................................ 9 Integrative Oncology Services ........................................................ 10 2014 Primary Cancer Cases Index ........................................................ 13 2014 Top Cancer Cases .......................................................................... 14 Cancer Conference Report .................................................................... 15 Eisenhower Lucy Curci Cancer Center Programs Overview of the Center .................................................................. 16 Eisenhower Schnitzer/Novack Breast Center.................................. 18 Arnold Palmer Prostate Care .......................................................... 21 Cancer Registry .............................................................................. 23 Cancer Support Services ................................................................ 24 Cancer Research ............................................................................ 26 Eisenhower BIGHORN Radiation Oncology Center ...................... 27 Eisenhower Infusion Centers .......................................................... 30 BIGHORN Behind a Miracle: Transforming Breast Care ................ 32 EISENHOWER MEDICAL CENTER Cancer Committee Members Eisenhower Medical Center Cancer Committee has had a significant impact on the Eisenhower Lucy Curci Cancer Center Program. A special thank you to the Cancer Committee members for their dedicated leadership and tireless efforts. Amy Law, MD Barbara Bigelow, RN, MSN, AOCNS, C-HPN Chair, Cancer Committee Advanced Practice Nurse, Oncology/Palliative Care Donna Boatman Murthy Andavolu, MD, Medical Oncology Coordinator, Community Outreach and Cancer Support Services James Cohn, MD, Radiology Bo Dunn, RN, MSN, OCN Luke Dreisbach, MD, Medical Oncology Radiation Oncology Frederick Eko, MD, Plastic Surgery Stephanie Farrell, MBA, BSN, RN, CCRC, CPHQ Varun Gupta, MD, Medical Oncology Director, Research Administration Vicki Koceja, RN-BC, OCN, MBA, FAAMA, PhD David Hyams, MD, General Surgery Chief Administrative Officer, Eisenhower Lucy Curci Cancer Center/Wound Care Center/Infectious Disease Center Robert Johnson, MD, Radiation Oncology Rupinder Mann, MD, Palliative Care Danielle Meglio, COTA/C, MLD/CDT Iliana Popescu, MD, Medical Oncology Occupational Therapy Ann Mostofi, RN, MSN Justin Reckard, MD, General Surgery Chief Nursing Officer and Vice President, Patient Care Services Patti Richardson, MD, Pathology Peter Schulz, MD, General Surgery Tijuana Parker, RN, MSN Director, Medical/Surgical 3 East/Oncology Youssef Tanagho, MD, Urology Tammy Plante, MHA, CTR, CHES Justin Thomas, MD, Pulmonary Disease Manager, Cancer Information Management Alison Mayer Sachs, MSW, CSW, OSW-C Henry Tsai, MD, Medical Oncology Director, Community Outreach and Cancer Support Services Davood Vafai, MD, Medical Oncology Cera Salamone Stanford, BSN, RN, PHN, NE-BC, HACP Clinical Director, Infusion Centers, Radiation Oncology, Hematology/Oncology and Arnold Palmer Prostate Center Belinda Zaparinuk, RT(M), BS, CBEC Manager, Eisenhower Schnitzer/Novack Breast Centers 2 EISENHOWER MEDICAL CENTER Eisenhower Lucy Curci Cancer Center Welcomes Chief Adminstrative Officer Dr. Koceja has a number of published articles including Developing Staff Nurse Shared Leadership Behavior in a Professional Nursing Practice, and Decreasing the days from detection to a diagnosis for women with the use of a Breast Care Coordinator during the diagnostic phase of care. Vicki Koceja, RN-BC, OCN, MBA, FAAMA, PhD, began her career in Oncology/HIV/AIDS nursing in the mid-1980s and has more than 29 years of direct oncology experience. She brings solid expertise as a clinical manager and administrative director in the design, development and implementation of oncology programs in Arizona, Wisconsin and Nevada. She recently completed a Fellowship with the Oncology Nursing Society, and also has a Fellowship from the American Academy of Medical Administrators. She has completed her Oncology Nursing Certification through the Oncology Nursing Society and is Board Certified in Pain Management. She is a Certified Trainer for the Oncology Nursing Society Chemotherapy Course, is certified through the National Consortium of Breast Centers as an Instructor of Breast Self-Exam, and is a national trainer for the Generalist Hospice/ Palliative Care Clinical Review, and a National End-of-Life Nursing Education Consortium trainer. In addition to her administrative duties in the area of oncology, she has developed nurse driven palliative care models. Her training in palliative care was established through the City of Hope, which provided a strong focus on program development. She has completed additional training through the Wisconsin Pain Initiative on pain management as well as end-of-life care through the Milwaukee County Hospital/Medical College of Wisconsin. She has served as the President of the Greater Las Vegas Chapter of the Oncology Nursing Society and as the State Director for the American Academy of Medical Administrators. She volunteers with the Nevada Cancer Coalition, the American Cancer Society, the Nevada Breast Coalition, and the Nevada Ovarian Coalition. In 2003, she received the March of Dimes Community Nurse of the Year award for community service. She currently serves as the Center’s Community Liaison II on the Board of the Desert Cancer Foundation. 3 EISENHOWER MEDICAL CENTER FOCUS CANCER SITE antecedent hematologic disorders that predispose patients to AML include aplastic anemia and certain myeloproliferative neoplasms (polycythemia vera, primary myelofibrosis or other, less common entities). Acute Myeloid Leukemia Overview and Management at Eisenhower Medical Center Constantin A. Dasanu, MD, PhD Medical Oncology and Hematology Among exogenous factors, radiation exposure and chemotherapy use play an important role. Antracyclines and alkylating agents used for the therapy of other cancers are well-studied risk factors, linked with particular subtypes of AML. The typical latency period between drug exposure and acute leukemia is about 3 to 5 years for alkylating agents and radiation exposure, but only 9 to 24 months for antracyclines. In these patients, AML is qualified as secondary, and they have a poorer prognosis than individuals with de novo acute leukemia. Notably, most patients with de novo The most common type of acute leukemia in adults, acute myeloblastic leukemia (AML) is a group of hematologic cancers characterized by the presence of more than 20% myeloblasts in the bone marrow. The American Cancer Society® estimates the average lifetime risk for AML at 1 in 227 for men and 1 in 278 for women. This results in approximately 18,860 new yearly AML cases and an estimated death toll at 10,460 per year. AML is more common in Caucasians than in any other ethnic group. Its prevalence increases with aging, the median age of onset being 70 years. AML have no identifiable risk factors. Maturational arrest of the bone marrow cells in the earliest stages of development is the hallmark of the AML pathophysiology. This process involves activation of abnormal genes through chromosomal translocations or other genetic abnormalities. Production of normal blood cells markedly decreases, which results in varying degrees of anemia, thrombocytopenia, and neutropenia. Rapid proliferation of blasts, along with reduced ability to undergo programmed cell death (apoptosis), results in their accumulation in the bone marrow, blood, and, sometimes, the spleen and liver. These patients are at risk for spontaneous tumor lysis syndrome, an oncologic emergency that, if left unattended, can lead to acute kidney failure and death. Several factors have been linked with AML, including antecedent hematologic disorders, certain familial syndromes and environmental exposures. An important risk factor for AML is the presence of an antecedent hematologic disorder such as a myelodysplastic syndrome (MDS). MDS represents a family of bone marrow diseases that manifest as progressive cytopenias and affect predominantly persons older than 65. Patients with high-risk MDS are more likely to develop AML than those with low-risk MDS. Other 4 EISENHOWER MEDICAL CENTER The workup for AML includes complete blood count and peripheral smear, bone marrow aspiration and biopsy, and analysis of genetic abnormalities. Immunopenotyping by flow cytometry is used to help distinguish AML from acute lymphocytic leukemia (ALL), and further classify the subtype of AML (M1 through M8). Cytogenetic findings in the bone marrow represent the most reliable prognostic indicators and can guide the treatment. Patients with translocations t(8;21), t(15;17), t(16;16), or inversion 16 have the best prognosis, with long-term survival rates of approximately 65%. These patients may not require allogeneic hematopoietic stem cell transplantation (HSCT). Patients with normal cytogenetic findings have an intermediate prognosis, with a long-term survival rate of approximately 25%. Patients with poor-risk cytogenetic findings (especially deletions of chromosomes 7 or 5) have a poor prognosis, with a long-term survival rate of less than 10%. The presence of an FLT3 mutation is associated with a poorer prognosis. Mutations in CEBPA are associated with a longer remission duration and longer overall survival. Mutations in NPM are associated with a better response to chemotherapy. Typical signs and symptoms of AML include excessive fatigue, easy bruising, mucosal bleeding, fever, bone pain and infection. Patients often retrospectively note a decreased energy level over past several months. They often have decreased neutrophil counts despite increased total white blood cell (WBC) counts. Many of them present with fever that may occur with or without documentation of an infection. The patients with the lowest absolute neutrophil count (ANC) (< 500 cells/µL, but especially < 100 cells/µL) have the highest risk of a serious infection. Patients may also present with bleeding gums and multiple ecchymoses. Bleeding may be caused by thrombocytopenia, coagulopathy that results from disseminated intravascular coagulation (DIC), or both. Potentially life-threatening sites of bleeding include the lungs, gastrointestinal tract and the central nervous system. In addition, some symptoms may result from the spleen, liver, gums and skin infiltration with leukemic cells. Infiltration occurs most commonly in patients with the monocytic (M5) or myelomonocytic (M4) subtypes of AML. Patients with splenomegaly may note fullness in the left upper quadrant or early satiety. Patients with gum infiltration often present to their dentist first. The patients with markedly elevated WBC counts (>100,000 cells/µL) can present with symptoms of leukostasis such as respiratory distress, dizziness or altered mental status. Deadly if left untreated, leukostasis is a medical emergency that calls for immediate leukapheresis. AML treatment depends on the biology of the disease and the patient's age and performance status. For the most part, we use combination chemotherapy plus postremission therapy that may include additional chemotherapy and allogeneic HSCT. If the patient is eligible for allogeneic HSCT, this is our approach for any intermediate- or high-risk patients with AML. However, HSCT neither cures every single patient nor is available to every patient. 5 EISENHOWER MEDICAL CENTER Patients are first stabilized with intravenous fluids, allopurinol and, if needed, antibiotics. Current standard induction chemotherapy for AML consists of an antracycline administered intravenously daily for 3 days and cytarabine continuous infusion for 7 days (e.g., 3+7 regimen). Patients who do not go into remission require a second course of Increasing age is an adverse factor as older patients more frequently have a previous antecedent hematologic disorder, along with comorbid medical conditions that compromise the ability to receive high-dose chemotherapy. Unfortunately, we are only able to cure fewer than 10% of adults older than 65 years with AML. This induction therapy. Consolidation therapy protocols vary, but high-dose cytarabine has been successfully used in younger patients. Hypomethylating agents (5-azacitidine, decitabine) are used in unsuitable candidates for standard induction therapy due to advanced age, co-morbidities or preference, especially when secondary AML is diagnosed or suspected. When receiving chemotherapy, patients should avoid exposure to crowded places and people with contagious illnesses, especially children with viral infections. Any patient with neutropenic fever or infection should immediately receive broadspectrum antibiotics. Appropriate transfusion support must be provided to all patients with AML. Blood products must be irradiated to prevent transfusion-associated graft versus host disease (GVHD) which can be fatal. Nonetheless, death in individuals with AML may result from an uncontrolled infection or hemorrhage that may happen even after use of appropriate blood products and antibiotic support. Evaluation of myocardial function is needed once the diagnosis of AML is confirmed as many of the chemotherapy agents used are cardiotoxic. Human leukocyte antigen (HLA) or DNA typing is required in patients who are potential candidates for allogeneic transplantation. is because standard induction chemotherapy followed by remission therapy is not effective in most of these patients, and many of them are not candidates for allogeneic HSCT. Almost universally, individuals older than 60 are offered reducedintensity alloSCT, that is less toxic while maintaining similar efficacy to the fully myeloablative approach. Nearly 10% of adults with AML have acute promyelocytic leukemia (APL or M3 subtype), usually with translocation t(15;17) involving the retinoic acid receptor gene. These patients have an excellent response to all-trans-retinoic acid (ATRA) plus either an antracycline or arsenic trioxide. These combinations have induced sustained remissions and cures in more than 90% of APL patients. In 2014, a total of 82 patients were diagnosed with AML and treated at Eisenhower Medical Center. Out of those, 47 were men and 35 were women. Eisenhower has vast experience in managing acute leukemia. Patients are offered high-dose chemotherapy as induction and consolidation therapy, when applicable. Most patients are then referred to a transplantation center for consideration of HSCT. Eisenhower offers AML patients highly specialized nursing care in the Oncology unit (3 East). The AML patients receive necessary blood product support, 6 EISENHOWER MEDICAL CENTER growth factor support, leukapheresis and hemodialysis as needed. Qualified candidates go on to receive allogeneic HSCT. Subsequently, our team of Medical Oncologists/Hematologists follow them at Eisenhower Lucy Curci Cancer Center jointly with the transplant physicians at the tertiary centers. Well-designed clinical trials using an array of new agents are available at larger university centers, aiming at obtaining robust remissions and increasing long-term survival of AML patients. In addition, some of these trials address the long-term effects of leukemia therapy. In the near future, we hope to be able to evaluate our patients for clinical trials involving targeted pharmacotherapy agents based on the molecular biology of this disease. These new agents are becoming more promising as we learn about the genes involved in the pathogenesis of AML. They include kinase inhibitors, epigenetic modifiers, and exportin inhibitors. In addition, new immunotherapy agents that are effective in other malignancies merit to be studied in AML. Our short-term goals include enrollment of patients in some of these clinical trials, and offering them qualified care and follow-up in our Leukemia and HSCT Survivorship clinics. Some long-term effects of AML treatment, such as moderately severe fatigue, can linger for years after therapy. Other long-term sequelae seen in the AML survivors include heart conditions, thyroid problems, lung damage, infertility, osteoporosis, hearing loss, cataracts, peripheral neuropathy, second cancers and long-term impairment of immune system function. Late complications also include depression, post-traumatic stress disorder, and cognitive effects such as problems with concentration, memory, and the ability to multitask (also called “chemo brain”). At Eisenhower Lucy Curci Cancer Center, patients are not only constantly screened for disease relapse, but also for these long-term consequences of AML therapy and are addressed promptly. The Social Services Department is extremely helpful at helping build a supportive network for the AML patients and their loved ones. 1. NCCN Clinical Practice Guidelines in Oncology. Acute Myeloid Leukemia: Version 2.2014. National Comprehensive Cancer Network. Available at http://NCCN Clinical Practice Guidelines in Oncology. Acute Myeloid Leukemia: Version 2.2014. Accessed: August 14, 2014. 2. American Cancer Society. (2014). Cancer facts and figures 2012. Retrieved from http://www.cancer.org/Research/CancerFacts Figures/index 3. American Cancer Society. (2014). Leukemia—Acute myeloid (myelogenous). Retrieved from http://www.cancer.org/acs/ groups/cid/documents/webcontent/003110-pdf.pdf While AML is currently viewed as a potentially curable disease, overall AML survival has improved only modestly for patients younger than 60 years over the last two decades. In 1966, the median survival of adult patients with AML was only 40 days; today, patients younger than 60 years have complete response rates of 70% to 80% after induction chemotherapy. Overall survival, however, remains at only about 50% for those who go into a complete remission or 30% overall. 4. Leukemia and Lymphoma Society. (2014). Managing your cancer: Long-term and late effects. Retrieved from http://www.lls.org/#/ diseaseinformation/managingyourcancer/survivorship/ longtermlateeffects 5. National Cancer Institute. (2014). Adult acute myeloid leukemia treatment (PDQ®). Retrieved from http://www.cancer.gov/ cancertopics/pdq/treatment/adultAML/healthprofessional 6. Lowenberg B, Pabst T, Vellenga E, et al. Cytarabine dose for acute myeloid leukemia. New England Journal of Medicine 2011;364(11):1027-36. 7 EISENHOWER MEDICAL CENTER chemotherapy: eleven (11) received (7+3) daunorubicin and standard-dose cytarabine treatment; one (1) received decitabine, and four (4) received 5-azacitidine treatments. Five of sixteen (16) or 31% of patients that received induction and subsequent consolidation treatments are alive at the time of this report. Adult Acute Myeloid Leukemia Amy Law, MD Chair, Cancer Committee Eisenhower Medical Center An estimated 19,000 people will be diagnosed with Acute Myeloid Leukemia (AML) in the United States in 2015. More than 55% of people diagnosed with AML will die of the disease with most deaths occurring in patients older than 65 years in the first year. Age at the time of an AML diagnosis impacts overall survival. Median age of diagnosis in the United States is 67 years with approximately a third diagnosed at older than 75 years of age. Patients with AML are often neutropenic which is associated with high morbidity. Treatment is divided into induction and consolidation therapy. Supportive care included use of transfusion support and infection management. A third of patients presented with febrile neutropenia at the time of diagnosis. Three (3) cases had identifiable source of infection: enterococcus and staphylococcus bacteremia and clostridium difficile colitis. Nine (9) patients had venous access device placements, seven (7) PICC lines and two (2) mediports. Only one (1) case of central line associated bloodstream infection with staphylococcus. Central vascular access device placements are ubiquitous in patients undergoing intensive or cyclic chemotherapy among cancer patients. Central line associated bloodstream infections are associated with morbidity. Neutropenia is a major risk factor for development of infections in patients with acute leukemia and cancer patients undergoing chemotherapy. Identifying patients at risk for neutropenia, preventing and managing infections in neutropenic patients is often a dynamic process, requiring a multidisciplinary treatment and management approach. Twenty-four (24) new cases of AML were diagnosed at Eisenhower Medical Center in 2013-2014. Thirteen (13) were male and eleven (11) were female. Median age at the time of diagnosis is 71 years, ranges 45-87. Seventeen (17) patients were older than 65 years, and a third diagnosed at older than 75 years. Six (6) patients aged 72 years and older chose supportive care at the time of diagnosis and died on hospice within five days of diagnosis. One (1) patient was transferred to her home in Canada, not allowing for follow-up. Eighteen (18) or 75% patients died of the disease. Sixteen (16) patients received induction Tijuana Parker, MSN, RN, OCN, Clinical Director, Inpatient Oncology Unit, and Barbara Bigelow, MSN, RN, AOCNS, along with expansive committees at Eisenhower Medical Center, led the charge in developing and implementing protocols and procedures for the care of patients with neutropenia. Multilingual neutropenic precaution signs for patients and visitors were enforced on 8 EISENHOWER MEDICAL CENTER Patient Advisory Committee the inpatient oncology unit. Policies on indications for central line necessity, maintenance and de-clotting of central lines were enforced. Vicki A. Koceja, RN-BC, OCN, MBA, FAAMA, PhD Chief Administrative Officer Eisenhower Lucy Curci Cancer Center Eisenhower Lucy Curci Cancer Center held its first Patient Advisory Committee meeting in June this year. The committee was developed with volunteer patients from all areas of service. The purpose? To focus on patient centered care to determine if the Cancer Center is offering patients the services they desire. Patients give direct feedback regarding the planning, development and implementation of new services with suggestions for improvements in the Center’s current services. The first meeting presented a new concept — the nurse navigator — a position that would be developed to address the complex needs of patients with specific diseases. For example, the Center’s Breast Care Navigator helps patients in the Breast Center through the process of additional tests necessary to rule out a cancer diagnosis. The nurse navigator follows the patient’s care through surgery and any subsequent treatment if a cancer diagnosis is confirmed. Nurse navigators will follow up with patients to see how they did with their tests, procedures, and treatments and are additionally focused on guiding the patient through all of the information that comes with a cancer diagnosis and treatment. This role would work with the multidisciplinary team to develop a plan of care identifying the patient’s goals for their care. In 2015, Eisenhower Medical Center received Magnet Recognition® by the American Nurses Credentialing Center after a rigorous multifaceted evaluation. Magnet recognition was granted partly based on developing and implementing quality initiatives that aim for safe, effective and patient centered care. A key quality initiative evaluated as part of Magnet recognition was reduction in Central Line Associated Bloodstream Infections. Multidisciplinary teams consisting of nursing, infection prevention and intravenous access staff participated in the initiative. Eisenhower effectively reduced the Central Line Associated Bloodstream Infections rates below the national Health Safety Network benchmark. 9 EISENHOWER MEDICAL CENTER The second new service would be the Patient Financial Counselor. The counselor role is being developed to work in conjunction with the physician’s plan of care and insurance companies to determine the overall out-of-pocket expenses that may arise. Additionally, the counselor would assist in finding programs that are available for patients to help with premiums, co-payments or prescription assistance programs. Integrative Oncology Services Alison Mayer Sachs, MSW, CSW, OSW-C Director, Community Outreach and Cancer Support Services, Eisenhower Lucy Curci Cancer Center Being a cancer patient is never easy. Whether you or someone you care about is a cancer patient, the journey from diagnosis through treatment and recovery is filled with many questions. Eisenhower Lucy Curci Cancer Center offers guidance, support, education and understanding to help every step of the way. The committee also discussed service preferences, asking if patients preferred services all on the same day or the option of having labs drawn one day in advance, allowing tests to be run in order to be prepared the next day for their treatments. Committee members stated they actually preferred the latter so they wouldn’t have to wait for lab test results that determine if treatment is needed. Cancer affects mind, body and soul, so the Cancer Center’s Integrative Oncology services are designed to meet the specific needs and concerns of cancer patients and their loved ones as well as the needs of our community as a whole. Incorporating the latest information on cancer prevention, detection, treatment and research into an array of programs helps calm the mind, strengthen the body and support the soul. The Patient Advisory Committee brings patients together with members of the health care team to help improve communication and coordination among all services. By providing the patient and family perspective, this collaborative process gives the health care team vital information needed to continue to provide the comprehensive and compassionate care that distinguishes Eisenhower Lucy Curci Cancer Center as a healing place like no other. Committed to treating the whole person, the Cancer Center’s goal is to nurture hope and healing for patients and their loved ones and to provide a healing place like no other. 10 EISENHOWER MEDICAL CENTER Integrative Oncology Services Center offers various support groups where participants can share personal experiences or just listen with other cancer patients and survivors. There is no fee to participate and new members are always welcome. ■ Social Work Services: Offering both short-term individual and family counseling, trained oncology social workers are available to help develop the emotional and social resources to deal with cancer and access needed community resources and services. ■ Exercise: Patients undergoing active treatment are looking for ways to combat fatigue, maintain muscle strength, and feel as though they have control over some part of their lives. Studies have shown patients and survivors may benefit from certain exercises, with many reporting improved appetite, lessening of fatigue, improvement in sleep patterns and overall improvement in quality of life. Partnering with Eisenhower’s Department of Rehabilitation Medicine, the Cancer Center offers classes focusing on strength training, movement, walking and yoga. ■ Genetic Counseling: Science and Research have shown that genes contribute to the development of certain cancers. The Cancer Center’s program offers genetic counseling with the only Certified Genetic Counselor (CGC) in the Coachella Valley, providing genetic counseling as well as education to our physicians and the community at large. ■ Nutrition: Cancer and cancer treatments can change patients’ eating habits and affect their appetite and nutritional needs, resulting in loss of appetite. Patients must pay special attention to nutrition in order to maintain their health and strength. The Cancer Center provides a registered dietician, available to meet with patients to evaluate their nutritional needs and provide follow-up care through all phases of their cancer treatment and recovery. Lectures on diet, nutrition and cancer are offered throughout the year. ■ Cancer Lecture Series and Lunch and Learn with the Expert: Maintaining a healthy lifestyle is important for all of us. That is why we offer ongoing lectures and educational presentations about treatment options and the latest in cancer prevention and detection. Eisenhower Lucy Curci Cancer Center also hosts teleconferences, community meetings, cancer screenings and other workshops. In addition, the Center is actively involved in the community and works in cooperation with local, regional and national cancer organizations such as the American Cancer Society, the Lung Cancer Alliance, the National Cancer Institute, the Oncology Nursing Society and the Association of Oncology Social Work. ■ Support Groups: According to the National Cancer Institute, “Often, support groups can help people affected by cancer feel less alone and can improve their ability to deal with the uncertainties and challenges that cancer brings. Support groups give people who are affected by similar diseases an opportunity to meet and discuss ways to cope with illness.” The Cancer 11 EISENHOWER MEDICAL CENTER ■ Stress Management and Relaxation: with insurance premiums, co-pays and costs of cancer treatments. Through a long-standing relationship with the American Cancer Society®, the Cancer Center provides on-site programs such as the bi-monthly Look Good, Feel Better and our weekly Wig Bank providing free wigs, hats and scarves to those undergoing treatment. Weekly Healing Touch Massage and classes on mindfulness meditation and guided imagery teach new approaches to working with stress, pain, chronic illness and the challenges of living with (or caring for a person with) a cancer diagnosis. ■ Cancer Resource Center: When it comes to ■ Smoking Cessation Program: The U.S. Surgeon cancer, knowledge is power. In the Harry and Joy Goldstein Cancer Resource Center — conveniently located on the first floor of the Cancer Center — the most comprehensive and up-to-date information about cancer prevention, diagnosis, treatment and research is available. Using the touch-screen computer, CancerHelp® General has said, “Smoking cessation represents the single most important step that smokers can take to enhance the length and quality of their lives.” Eisenhower Lucy Curci Cancer Center offers the community a Stop Smoking program based on the American Cancer Society’s Freshstart® program. Open to anyone instantly connects to the National Cancer Institute’s data base, providing information that is updated monthly and available in both English and Spanish. ready to commit to becoming a non-smoker, regardless of their age, how much or long they have been smoking, the program offers the participants the tools necessary to break their nicotine addiction and use behavior modification techniques to help stay smoke free. Unique to the Cancer Center’s program is the addition of a monthly support group allowing those who have graduated from the program to check-in with each other and discuss their challenges and their achievements. ■ Community Partnerships: Working with our non-profit community partners, Eisenhower Lucy Curci Cancer Center is able to provide a safety net for cancer patients and their families through direct referrals for basic needs such as food vouchers, assistance in covering monthly bills for utilities, rent or mortgage, and help 12 2014 EMC Primary Cancer Cases Index Site Group ALL SITES Breast Prostate Lung/Bronchus-Non Sm Cell Bladder Colon Leukemia Other Hematopoietic Non-Hodgkin’s Lymphoma Pancreas Melanoma of Skin Unknown or Ill-Defined Other Nervous System Kidney and Renal Pelvis Brain Rectum and Rectosigmoid Ovary Thyroid Myeloma Lung/Bronchus-Small Cell Liver Anus, Anal Canal, Anorectum Corpus Uteri Stomach Esophagus Soft Tissue Testis Tonsil Tongue Bile Ducts Other Female Genital Other Digestive Pleura Cervix Uteri Other Endocrine Small Intestine Gallbladder Larynx Other Skin Cancer Vulva Salivary Glands, Major Mouth, Other and Nos Ureter Lip Oropharynx Nasal Cavity, Sinus, Ear Uterus Nos Hodgkin’s Disease Nasopharynx Hypopharnyx Pharynx and Ill-Defined Bone Kaposi’s Sarcoma Penis Other Urinary Class Sex Total F Other 0 Cases Analytic NonAn Other M 2069 1685 371 13 1066 1000 3 147 321 264 55 2 3 318 0 55 226 147 77 2 226 0 0 0 217 195 20 2 108 109 0 2 135 110 25 0 120 15 0 68 117 107 10 0 68 49 0 1 82 47 35 0 57 25 0 0 80 55 23 2 46 33 1 0 76 55 21 0 38 38 0 0 75 63 12 0 45 30 0 0 72 61 11 0 46 26 0 10 71 66 3 2 39 32 0 0 70 64 6 0 21 49 0 0 53 47 6 0 32 21 0 1 49 39 7 3 30 18 1 0 45 41 4 0 29 16 0 2 38 23 15 0 0 38 0 0 37 34 3 0 11 26 0 0 31 21 10 0 18 13 0 0 29 27 2 0 13 16 0 0 26 21 5 0 21 5 0 0 25 21 4 0 15 10 0 5 19 15 4 0 0 19 0 1 17 16 1 0 13 4 0 0 14 9 5 0 12 1 1 0 14 8 6 0 7 7 0 0 12 11 1 0 12 0 0 0 10 8 2 0 8 2 0 1 8 7 1 0 6 2 0 0 8 7 1 0 3 5 0 0 8 8 0 0 0 8 0 0 7 7 0 0 6 1 0 0 7 7 0 0 5 2 0 0 7 3 4 0 0 7 0 0 7 5 2 0 1 6 0 0 6 5 1 0 3 3 0 0 6 5 1 0 1 5 0 0 6 6 0 0 4 2 0 1 6 5 1 0 4 2 0 0 6 3 3 0 0 6 0 0 3 3 0 0 2 1 0 0 3 3 0 0 1 2 0 0 3 3 0 0 2 1 0 0 2 2 0 0 2 0 0 0 2 2 0 0 1 1 0 0 2 1 1 0 2 0 0 0 2 0 2 0 0 2 0 0 2 2 0 0 2 0 0 0 1 1 0 0 0 1 0 0 1 0 1 0 0 1 0 0 1 1 0 0 0 1 0 0 1 1 0 0 0 1 0 0 1 1 0 0 1 0 0 0 1 1 0 0 1 0 0 0 1 1 0 0 1 0 0 0 Stage I II III IV Unknown N/A Missing 399 113 18 61 22 24 1 0 8 9 27 0 0 27 0 15 3 18 0 2 7 3 7 2 0 4 7 1 2 1 0 0 1 1 0 0 0 4 2 1 1 1 1 2 1 0 0 0 1 0 0 1 0 0 0 278 50 91 13 19 31 0 0 12 6 11 0 0 3 0 7 3 7 0 1 2 4 2 1 2 2 0 0 2 1 0 0 0 1 0 0 1 1 1 2 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 206 33 16 37 0 26 1 0 8 6 9 0 0 4 0 10 9 5 0 3 5 6 1 5 3 2 3 2 0 0 2 0 1 0 0 4 1 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 278 10 14 77 5 23 0 0 26 41 3 0 0 9 0 4 7 2 0 21 2 2 3 6 3 0 0 3 3 1 0 0 3 1 0 1 3 0 0 0 1 2 0 0 1 0 0 1 0 0 0 0 0 0 0 46 3 8 4 6 1 0 0 1 1 1 0 0 3 0 3 1 2 0 0 2 1 1 2 1 0 0 1 0 2 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 331 0 0 1 0 1 55 55 0 0 0 66 64 0 39 0 0 0 21 0 3 0 0 0 0 0 1 0 0 2 6 7 1 0 5 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 EISENHOWER MEDICAL CENTER At 15 percent of total cases, breast 2014 Top Cancer Cases cancer continues to be the most There were 2,069 total cancer cases accessioned for Eisenhower frequent cancer site receiving care at Medical Center in 2014. The 2014 Primary Site table outlines Eisenhower Medical Center. Next, each cancer site by class, sex and stage at diagnosis (previous lung, prostate, colorectal and bladder page). The pie chart below compares the incidence of each of cancer complete the top five sites at the top five cancer sites in 2014 at Eisenhower Medical Center. 12, 11, 9 and 7 percent, respectively. 2014 Eisenhower Medical Center Top Five Sites of Total Cases Breast, 15% 321 Cases Lung, 12% 246 Cases Remaining Cases 46%, 954 Cases Prostate, 11% 226 Cases Bladder, 7% 135 Cases Colorectal, 9% 187 Cases 14 EISENHOWER MEDICAL CENTER Cancer Conference Report Multidisciplinary cancer conferences are vital to the patient care process. Also known as Tumor Boards, the conferences bring together physicians and other health care professionals to plan treatment on individual cases. Tumor Boards are an opportunity for the review of diagnostics and to recommend treatments for optimal patient care. These conferences provide excellent educational benefits for attendees and valuable multidisciplinary consultative and treatment guidance benefits for our patients. Cancer Conference case presentations are open to staff physicians. Eisenhower Medical Center currently has a Main Tumor Board with case presentations from all sites, as well as specialty tumor boards in breast, lung, gastrointestinal, brain and urological cancer sites. Please call the Cancer Registry to schedule a Tumor Board case at 760-773-1511. Through the commitment of many physicians at Eisenhower Medical Center, 475 cancer cases were discussed at Tumor Boards in 2014, including 97 percent prospective case presentations. The Tumor Boards were well attended by representatives from Medical Oncology, Radiation Oncology, Surgery, Pathology, Radiology, Nursing, Social Services, Clinical Research, Cancer Registry and other medical professionals, exceeding the goals set by the Cancer Committee. The Main Tumor Board is held on the first and third Mondays at the Annenberg Center for Health Sciences dining room. Breast Tumor Board meetings are held bi-monthly at Eisenhower Lucy Curci Cancer Center. A Gastrointestinal Tumor Board, Urology Tumor Board and a Thoracic Tumor Board are held monthly at Eisenhower Lucy Curci Cancer Center. A Brain 15 2014 Tumor Board Case Presentations Topic Number Breast............. 220 Prostate............ 18 Lung................. 80 Colorectal ........ 58 Bladder-Kidney . 11 Hematopoietic ...11 Topic Number Head & Neck/ CNS ............... 37 Gastrointestinal ..14 Unknown or Ill-Defined ....... 2 Skin..................... 3 Other Cases ......20 GYN ................... 1 Total number of cases......................... 475 Tumor Board is held monthly with discussion of primary brain/CNS lesions and cancers with brain metastasis. In 2014, 736 physicians and 680 additional health care professionals attended Eisenhower Medical Center Tumor Boards. The Annenberg Center for Health Sciences at Eisenhower hosts Grand Rounds, Main Tumor Boards, and many other educational programs. In 2014, there were 49 Grand Rounds educational presentations on treatment issues pertaining to cancer patients. For more information on upcoming Grand Round topics, call 760-773-4500. EISENHOWER LUCY CURCI CANCER CENTER Overview of Eisenhower Lucy Curci Cancer Center Unrivaled Medical Care Eisenhower Lucy Curci Cancer Center is truly a remarkable cancer treatment facility, bringing together in one place a tremendous technological strength and a profoundly human environment. We offer the cancer patient state-of-the-art medical care and comprehensive cancer services. Treatment is provided by caring and for the person as well as the cancer, Eisenhower Lucy Curci Cancer Center is indeed a healing place like no other®. Simply the Best There is a reason that more people choose Eisenhower Lucy Curci Cancer Center for all of their cancer care when facing the diagnosis of cancer. Eisenhower Lucy Curci Cancer Center is accredited by the American College of Surgeons (ACOS), one of only a few hospitals to attain this accreditation in Riverside County. More than 1,500 cancer programs attain ACOS accreditation in the United States, yet these accredited centers treat nearly 70 percent of cancer patients in the nation. Coachella Valley to receive the award for two consecutive periods. The Cancer Center maintains the highest standards of care and is accredited by the American College of Radiology, which accredits all facilities providing mammography on behalf of the United States government. Eisenhower Medical Center is accredited by The Joint Commission, the leader in accreditation and certification of health care organizations, and is a member of the prestigious Eastern Cooperative Oncology Group, one of the largest clinical cancer research organizations in the United States. One of only nine participating organizations in the state of California, Eisenhower has access to more than 90 active clinical trials. Additionally, the Cancer Center is designated a Lung Cancer Screening Center by the American College of Radiology and a Screening Center of Excellence by the Lung Cancer Alliance. The Infusion Centers are recipients of the Press Ganey Guardian of Excellence Award℠ in Patient Excellence – an award given to organizations that have consistently achieved the 95th percentile for patient satisfaction. The Center received the Commission on Cancer (CoC) Outstanding Achievement Award (OAA) from the American College of Surgeons in March 2010. The award is among the most prestigious for cancer centers and Eisenhower Medical Center is the first hospital in the The Clear Choice for Your Cancer Care Eisenhower Lucy Curci Cancer Center is an extraordinary facility, nationally accredited and clinically distinguished. The healing environment, the uncompromising care, the personalized services, the team of professionals coming together to care for you and your loved ones are critical components to top notch cancer treatment. If you have questions or would like to learn more about services and treatment options at Eisenhower Lucy Curci Cancer Center, please call 760-674-3602, or visit our website at emc.org/cancer. EISENHOWER LUCY CURCI CANCER CENTER Comprehensive Cancer Services Eisenhower BIGHORN Radiation Oncology Center provides convenient access to some of the most advanced equipment and newest technology in treating malignant conditions, designed to meet your individual needs, including the combined Novalis Tx™ radiosurgery platform with RapidArc™ radiation technology to treat a wide range of cancer and neurological disorders. Arnold Palmer Prostate Care offers a unique blend of high-tech treatment, personal service, and compassionate, confidential care. Eisenhower Schnitzer/Novack Breast Center offers access to complete breast care, from screening mammography through diagnosis and follow-up. The compassionate healing environment at our multiple convenient Breast Center locations is the very hallmark of clinical excellence, melding the best technologies with passionate patient care – creating the most nurturing, welcoming and affirming surroundings. Eisenhower Imaging Center is on the leading edge of the most advanced technology and a model for imaging facilities worldwide. Cancer Support Services is designed to meet the specific needs and concerns of cancer patients and their family and friends every step of the way. We incorporate the latest information on cancer treatment and research into an array of programs to help strengthen the body, physically, spiritually and emotionally. Our goal is to nurture hope and healing for our patients and their families. Leo and Gloria Rosen Infusion Center staff understands the challenges, both physical and emotional, that affect every patient and their loved ones. That is why our team of registered nurses is experienced in infusion services, certified in chemotherapy administration and available to provide information and answer questions. 17 EISENHOWER LUCY CURCI CANCER CENTER Eisenhower Schnitzer/Novack Breast Center ■ Streamlined scheduling and registration reduces wait time. Woman-centered care in a warm, supportive environment. ■ Having your mammography breast exam performed at any of our beautifully appointed facilities. The compassionate healing environment of our breast centers is the very hallmark of clinical excellence, melding the very best technologies with passionate patient care — creating the most nurturing, welcoming and affirming surroundings at our multiple convenient locations. ■ Board certified, fellowship-trained radiologists — physicians dedicated to breast health — are the foundation of the Center and truly understand the concerns and needs of women. ■ State-of-the-art digital threedimensional tomosynthesis mammography equipment. ■ Computer-aided detection (CAD) software improves the accuracy of every mammogram. ■ Certified mammography and breast ultrasound technologists. The Eisenhower Schnitzer/Novack Breast Center offers an approach to women’s health care that is comprehensive, convenient and caring. Here you have access to complete breast care, from screening mammography through diagnosis and follow-up. Diagnostic findings and best treatment options for women diagnosed with breast cancer are discussed at collaborative biweekly multidisciplinary patient care conferences. A breast nurse specialist is available to act as guide throughout the entire diagnosis, treatment and follow-up process for the benefit of our patients. While our focus is breast health care, our goal is your peace of mind. Getting your mammogram here offers distinct advantages. Whether it is your annual check-up or an advanced procedure, having it at the Eisenhower Schnitzer/Novack Breast Center means you benefit from: Providing excellence in all aspects of breast imaging. ■ Additional diagnostic tools for follow-up exams are offered in cases of suspicious lumps or lesions, or difficult-to-read mammograms. The Eisenhower Schnitzer/Novack Breast Center offers convenient locations for your annual breast exam in Rancho Mirage or La Quinta. To schedule an appointment for your mammogram, please call 760-773-4338. Please request your appointment at the location that is most convenient for you. Eisenhower Schnitzer/Novack Breast Center is designated an American College of Radiology Breast Imaging Center of Excellence and is the first facility in the Coachella Valley to earn this prestigious designation. If you have questions or would like to learn more about services at any of our Eisenhower Schnitzer/Novack Breast Center locations in Rancho Mirage and La Quinta, please call 760-773-2038, or visit emc.org/breast. EISENHOWER LUCY CURCI CANCER CENTER Comprehensive Program Services acquire the unique anatomical coronal plane not available using conventional ultrasound. The Eisenhower Schnitzer/Novack Breast Center is the only place you need for your breast care. Breast Specific Gamma Imaging (BSGI): Eisenhower was the first facility in Southern California to offer BreastSpecific Gamma Imaging, a technology that more accurately identifies breast cancer previously undetected by mammography. Clinically proven as an effective device in the early detection of breast cancer, BSGI functions as a complementary diagnostic tool following difficult-to-read mammograms. Patients with dense breast tissue, multiple suspicious lesions, breast implants, a previously diagnosed mass, or those using Hormone Replacement Therapy will benefit most from BSGI. Screening mammography: With the advances in the treatment of breast cancer, the best chance for survival remains early detection. And the key to early detection is regular mammograms. The Center offers stateof-the-art digital threedimensional tomosynthesis mammography equipment enhanced with computeraided detection software, as well as education to encourage women to stay on top of their health. As a service to our patients, we send reminders when it is time to make an appointment for a mammogram. Accurate diagnosis and evaluation: Our fellowshiptrained physicians and personal nurse navigators provide our patients with personalized, experienced, expert care, complemented by state-of-the-art technology. A variety of imaging methods are available to accommodate every woman and her unique needs. Contrast Enhanced Spectral Mammography (CESM): Eisenhower was the first facility in the desert to offer CESM, performed as an adjunct to inconclusive mammography and ultrasound, SenoBright® contrast-enhanced spectral mammography highlights areas of unusual blood flow patterns. The system automatically acquires the spectral data necessary to automatically create two images per view; a standard mammographic image showing tissue density and a contrast-enhanced image in exactly the same position with the background signal subtracted out. Breast MRI: Eisenhower offers a dedicated breast MRI, which may aid in showing spots the breast that may or may not be cancer. A breast MRI is generally used to complement a mammogram for women with certain conditions, family history or other factors. Our fellowship-trained physicians will recommend the best imaging capability for your body and needs if such follow-up is required. Whole Breast Ultrasound: We are the first facility in Southern California to add the ACUSON S2000™ Automated Breast Volume Scanner (ABVS), a highly advanced, multi-purpose ultrasound system ideally suited to patients with dense breast tissue or a history of breast disease. This 3-D ultrasound technology enables never-before-seen detail resolution and the ability to 19 EISENHOWER LUCY CURCI CANCER CENTER Stereotactic breast biopsy is a safe, minimally invasive biopsy that obtains tiny samples from an identified abnormal breast mass for examination. A sample of suspicious breast tissue is precisely located with computer-guided imaging and removed with a needle. Eisenhower is the first breast center in Southern California to offer the Giotto next generation stereotactic table, ensuring comfortable positioning for patients while allowing 360-degree access of the breast. This outpatient procedure requires no hospitalization or surgical incision and is performed using only local anesthesia. Ultrasound Guided Core Biopsy is a safe, minimally invasive biopsy that obtains tiny samples from an identified abnormal breast mass for examination. A sample of suspicious breast tissue is precisely located with ultrasound guidance and removed with a vacuum assisted needle. This outpatient procedure requires no hospitalization or surgical incision and is performed using only local anesthesia. Bone density screening (Dexa Scan): This comprehensive X-ray measures the strength of your bones and provides important information for the treatment and prevention of osteoporosis. The test is safe, painless, quick and accurate. 20 EISENHOWER LUCY CURCI CANCER CENTER Arnold Palmer Prostate Care at Eisenhower Lucy Curci Cancer Center Arnold Palmer for the person as well as the cancer, the Eisenhower Lucy Curci Cancer Center is indeed a healing place like no other. Interdisciplinary Team Approach Since undergoing prostate surgery in 1997, Arnold Palmer has Through collaboration and commitment, brought the same level of commitment to prevention, treatment an interdisciplinary team approach is used and cure of prostate cancer that he brought to the game of golf. in the treatment management of prostate Throughout his career, Arnie enjoyed a long and close relationship cancer at the Arnold Palmer Prostate with President Dwight D. Eisenhower, which is why Arnie lent his Center. The coordinated efforts of urology, name to the Prostate Center. radiation oncology and medical oncology staff are utilized to create a cohesive multi-faceted program, assuring that your care is of the highest professional quality. Your primary care physician is also part of this team and will receive information regarding your personal treatment options and outcomes. Your nurse will work closely with you and Arnold Palmer Prostate Care offers a unique blend of high-tech the interdisciplinary team guiding you treatment, personal service, education and compassionate, throughout your treatment experience, confidential care. coordinating and optimizing your time, The Eisenhower Lucy Curci Cancer Center is truly a remarkable cancer ensuring any questions or concerns that treatment facility, bringing together a tremendous technological may arise are answered to your satisfaction strength and a profoundly human environment available nowhere and arranging any follow-up visits. else in the desert. We offer the cancer patient unrivaled medical care and comprehensive cancer services. Treatment is provided by caring and gentle health care professionals who are always considerate of your dignity and comfort. Our environment nurtures and calms the spirit with the soothing surroundings that incorporate the colors of nature. Caring Your Prostate Cancer Treatment. Whether you are a resident of Coachella Valley, or plan to be treated while staying at one of the many area resorts, Arnold Palmer Prostate Care at Eisenhower Lucy Curci Cancer Center offers a blend of high-tech treatment and individualized compassionate, confidential care for every patient. If you have questions or would like to learn more about services and treatment options at Arnold Palmer Prostate Care, please call 877-674-3800 or 760-674-3838, or visit emc.org/prostate. EISENHOWER LUCY CURCI CANCER CENTER The Latest Prostate Treatment Options Nerve-Sparing Prostatectomy is a modified form Treatment options which you may discuss with your of radical prostatectomy. When prostate nerves are physician include: cancer-free, only the prostate gland is removed and the nerves are preserved. External Beam Radiation Therapy (EBT) uses stateof-the-art linear accelerators to deliver radiation to a Robotic Prostate Surgery: da Vinci® Prostatectomy – precise location within the body. A series of three- Eisenhower Medical Center was the first facility in the dimensional radiation beams are tailored to the size, Coachella Valley to offer this less invasive procedure, shape and location of the tumor or cancer cells to stop which offers such benefits as a shorter hospital stay, their growth and reproduction while sparing the less pain, less risk of infection, less blood loss, less surrounding healthy tissue. scarring, faster recovery and a quicker return to normal activities. The da Vinci Surgical System has been used Image Guided Intensity Modulated Radiation worldwide in thousands of prostate cancer procedures, Therapy (IMRT) treats tumors that were previously resulting in excellent patient outcomes with respect to considered untreatable due to their size or location cancer control, urinary continence and maintenance of with an extremely precise variable beam intensity. sexual function. Image Guided Radiation Therapy (IGRT) uses UroNav Fusion Biopsy System from Invivo brings the radiation treatment guided by daily imaging and a power of MRI to the urology suite with the introduction tracking system to pinpoint tumor sites and adjust of the UroNav Fusion Biopsy System — the next patient positioning, allowing for precise delivery of generation of prostate care. UroNav’s state-of-the-art radiation to the tumor site and minimizing the amount technology fuses pre-biopsy MR images of the prostate of surrounding healthy tissue exposed to radiation with ultrasound-guided biopsy images in real time, for during the treatment. excellent delineation of the prostate and suspicious lesions, as well as clear visualization of the biopsy needle. 22 EISENHOWER LUCY CURCI CANCER CENTER Cancer Registry A state mandate in 1985 required all cancers diagnosed in California to be reported to the California Department of Health Services in an effort to better understand cancer and to develop strategies for its prevention, treatment and management. Federal law now requires state reporting, and an information collection system has been designed to obtain specific data on all cancer patients nationwide. ■ The patient’s re-admission to the hospital or outpatient visit is automatically updated in the registry. ■ The patient’s physician will be contacted if the patient has not received any service from Eisenhower Medical Center during the previous year. ■ If these update attempts are unsuccessful, a patient letter will be sent to the last known address as these statistics are vital to ensure accurate survival statistics. How You Can Help Operated by specially trained staff, Eisenhower Medical Center Cancer Registry utilizes a highly sophisticated computer system designed to document details of diagnosis, treatment and follow up of each cancer patient. How It Helps While strictly maintaining patient confidentiality, the Cancer Registry provides statistical cancer information vital to saving lives and ultimately, defeating cancer. How It Works Cancer patients are automatically enrolled in the registry database after receiving medical care at Eisenhower Medical Center. The Cancer Registry tracks a patient’s health status annually in the following ways: Evaluating, If you receive a letter, please complete and return it to the Cancer Registry in the envelope provided. It is also important to include any address or physician changes. If you prefer, you can also call us directly at 760-773-1511. The state uses this information to identify preventable causes of cancer, observe treatment outcomes to help identify the best therapies, and track survival rates. All diagnostic information, treatment data and follow-up history submitted is strictly confidential and provided in statistical form only. Periodic reports are also utilized by the hospital in an effort to maintain the highest treatment quality and provide insight on improving patient care. Ever wonder how the American Cancer Society® compiles their statistics? Or, how physicians predict the outcomes of certain cancers or know which treatments Monitoring and were the most effective? This information is gathered from Cancer Registries. Improving If you have questions or would like to learn more about our Cancer Registry, Patient Care please call 760-773-1511. Cancer screening and early cancer detection changes patient outcomes! EISENHOWER LUCY CURCI CANCER CENTER Cancer Support Services ■ Social Work/Case Management It’s hard to be a cancer patient. Whether you or someone you care about is a cancer patient, the journey from diagnosis through treatment and recovery is filled with many questions. At Eisenhower Lucy Curci Cancer Center, we offer guidance, support and understanding to help you every step of the way. The Harry and Joy Goldstein Resource Center offers patients and family or friends a place to gather information about the latest detection, prevention and treatment options for cancer. Our support services are designed to meet the specific needs and concerns of cancer patients and their family and friends. We incorporate the latest information on cancer treatment and research into an array of programs to help strengthen the body, physically and emotionally. Our goal is to nurture hope and healing for our patients and their families. Cancer Support Services Every individual is unique and so is every cancer patient. That is why we have a variety of programs and services available to help each of our patients and their families. Learning about cancer is an important part of treatment. Sometimes, just talking with someone can be healing. Short-term individual and family counseling with trained oncology social workers is available to help you develop the emotional and social resources to deal with cancer. ■ Genetic Counseling Science and research have shown that genes contribute to the development of certain forms of cancer. Our program provides genetic counseling with the only Certified Genetic Counselor (CGC) in the Coachella Valley. The Genetic Counselor provides education to physicians and the community as well as genetic testing and counseling. ■ Nutrition Cancer and cancer treatments can change eating habits, affecting appetites and nutritional needs. Treatment side effects can result in loss of appetite, and patients need to pay special attention to nutrition in order to maintain their health and strength. Our Cancer Center provides a registered dietitian, available to meet with patients to evaluate their needs and provide follow-up care through the phases of their cancer treatment and recovery. Lectures on diet and nutrition are offered throughout the year. We’re here for you. Eisenhower Lucy Curci Cancer Center is a resource for the entire community. You don’t have to be a patient to take advantage of all that we offer. If you or someone close to you has cancer, we’re here for you. If you have questions or would like to learn more about any aspect of Cancer Support Services, please call 760-834-3798, or visit emc.org/cancersupport. 0 EISENHOWER LUCY CURCI CANCER CENTER Center – conveniently located on the first floor of the Cancer Center − the most comprehensive and up-to-date information about cancer diagnosis, treatment, prevention and research is literally at your fingertips. With a touch-screen computer, an electronic catalog of information called CancerHelp® accesses more than 100 National Cancer Institute-certified websites. It is easy to use whether you have had a lot or a little experience with computers. ■ Support Groups According to the National Cancer Institute: Often, support groups can help people affected by cancer feel less alone and can improve their ability to deal with the uncertainties and challenges that cancer brings. Support groups give people who are affected by similar diseases an opportunity to meet and discuss ways to cope with illness. We offer various support groups where participants can share personal experiences or just listen with other cancer patients and survivors. There is no fee to participate and new members are always welcome. The CancerHelp® system is updated monthly, so you can always find the latest information available. Information is explained in easy-to-understand terms and is available in English and Spanish. ■ Cancer Lecture Series Learning about cancer is an important part of treatment. That is why we offer ongoing lectures and educational presentations about treatment options and the latest in cancer prevention and detection. ■ Community Partnerships Working with our non-profit community partners, Eisenhower Lucy Curci Cancer Center is able to provide a safety net for cancer patients and families through direct referrals for basic needs such as food vouchers, assistance in covering monthly bills for utilities, rent or mortgage, and help with insurance premiums, co-pays and costs of cancer treatments. Eisenhower Lucy Curci Cancer Center also hosts teleconferences, community meetings, cancer screenings and other workshops. In addition, the Center is actively involved in the community and works in cooperation with local, regional and national cancer organizations such as the American Cancer Society, the National Cancer Institute and the Department of Health and Human Services. Through our long-standing relationship with the American Cancer Society®, we provide on-site programs such as the bi-monthly Look Good, Feel Better and our weekly Wig Bank providing free wigs, hats and scarves to those undergoing treatment. ■ Exercise for Cancer Patients Patients undergoing treatment are looking for ways to combat fatigue, maintain muscle strength, and feel as though they maintain control over some part of their lives. Studies have shown patients may benefit from certain exercises, with many reporting improved appetite, lessening of fatigue, improvement in sleep patterns and overall improvement in quality of life. Partnering with Eisenhower Medical Center’s Rehabilitation Services, we offer a variety of on-site exercise classes. May is Skin Cancer Awareness Month, during which we partner with staff physicians (dermatologists and primary care physicians) to offer free skin cancer screenings to our community. Classes on Mindfulness Meditation and weekly Healing Touch Massage are offered through our Stress Management and Relaxation Program. The program teaches new approaches to working with stress, pain, chronic illness and the challenges of living with a cancer diagnosis. The goal of the program is to help restore a sense of balance, hope and wellbeing for cancer patients and their caregivers. ■ Harry and Joy Goldstein Cancer Resource Center When it comes to cancer, knowledge is power. At our Harry and Joy Goldstein Cancer Resource 25 EISENHOWER LUCY CURCI CANCER CENTER Cancer Research For the past several decades, clinical trials have been integral in the advancement of cancer treatment. Before medical advances in cancer or other disease states can be offered to the general public, they must be evaluated and approved through rigorously structured research studies, called clinical trials, involving human volunteers. ■ If the approach being studied is found to be helpful, patient may be among the first to benefit ■ Opportunity to make a valuable contribution to cancer research Types of Clinical Trials Prevention trials test new approaches, such as medicines, vitamins, minerals, or other supplements that doctors believe may lower the risk of a certain type of cancer or may prevent cancer from coming back or a new cancer in people who have already had cancer. Screening trials test the best way to find cancer, especially in its early stages. Participation in cancer research is an important commitment of Eisenhower Lucy Curci Cancer Center in its mission to provide the best cancer treatment. In support of its mission, Eisenhower Medical Center has affiliated with Stanford Cancer Center to offer National Cancer Institute-endorsed phase II and III, multi-center, randomized, clinical trials and is just one of the aspects of the advanced care that the Center offers. Clinical trials available through Eisenhower Lucy Curci Cancer Center are helping to find new and better treatments for those diagnosed with cancer. Today’s cancer treatments are yesterday’s clinical trials. Every cancer treatment that is used today began with research in a clinical trial. As a patient, there are potential benefits from participation in clinical trials, including: ■ Health care provided by leading physicians in the field of cancer research ■ Access to new drugs and interventions before they are widely available ■ Close monitoring of our patient’s health care and any side effects ■ More active patient participation role in own health care Treatment trials test new treatments like a new cancer drug, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as gene therapy. Diagnostic trials study new tests or procedures that may help identify, or diagnose, cancer more accurately. Diagnostic trials usually involve people who have some signs or symptoms of cancer. Quality of life, or supportive care, trials explore ways to improve comfort and quality of life for cancer patients. Patient participation is key to the success of cancer research. Patients who participate in clinical trials play a critical role in the development of advancements in the Today’s cancer treatments are yesterday’s clinical trials. Patient participation is key to the success of cancer research. “Our ability to offer national clinical trials, endorsed by the National Cancer Institute, ensures our patients receive health care as it should be by providing world-class treatment right here on the Eisenhower Medical Center campus,” says Stephanie Farrell, MBA, BSN, RN, CCRC, CPHQ, Director, Research Administration. For a listing of current trials at Eisenhower, visit emc.org/clinicaltrials, or for more information or to inquire about enrolling a patient, call 760-837-8034. EISENHOWER LUCY CURCI CANCER CENTER ■ S1207: Phase III Randomized, Placebo-Controlled Clinical Trial Evaluating the Use of Adjuvant Endocrine Therapy +/- One Year of Everolimus in Patients with High-Risk, Hormone Receptor-Positive and HER2/neu Negative Breast Cancer treatment of cancer. “We are honored that our patients participate in research. Curing all cancer is the ultimate goal of clinical trials. Hopefully, each trial they participate in will get us one step closer to finding a cure for cancer,” states Luke Dreisbach, MD, Chairman, Clinical Cooperative Research Work Group, Eisenhower Medical Center. ■ S1400: Phase II/III Biomarker-Driven Master Protocol for Second Line Therapy of Squamous Cell Non-Small Cell Lung Cancer (NSCLC) Since 2006, the clinical research program at Eisenhower Lucy Curci Cancer Center has received commendations, the highest honor, during the tri-annual American College of Surgeons Cancer Center Survey. The clinical research program has been recognized for providing patients with information about cancer-related clinical trials and enrolling our patients in screening, prevention or treatment trials. Eisenhower Lucy Curci Cancer Center’s pursuits in clinical research ensure that our patients receive the five-star treatment they have come to expect from Eisenhower Medical Center. ■ S1320: A Randomized Phase II Trial of Intermittent Versus Continuous Dosing of Dabrafenib and Trametinib in BRAFV600E/K Mutant Melanoma ■ I-ELCAP: Lung cancer detection program using Low Dose CT screening for smokers or previous smokers ■ FAMRI/I-ELCAP: Study to determine the likelihood of specific pulmonary diseases, including chronic obstructive pulmonary disease (COPD), emphysema, lung cancer, cardiac disease, and other diseases in never smokers exposed to secondhand smoke ■ S0820: A Phase III Double Blind Placebo-Controlled Trial of Eflornithine and Sulindac to Prevent Recurrence of High Risk Adenomas and Second Primary Colorectal Cancers in Patients With Stage 0-III Colon Cancer Clinical Trial Participation — A Best Practice in the Care of Cancer Patients The National Comprehensive Cancer Network (NCCN) believes that the “best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.” (www.nccn.org) ■ S1403: A Randomized Phase II/III Trial of Afatinib Plus Cetuximab Versus Afatinib Alone in Treatment-Naive Patients with Advanced, EGFR Mutation Positive Non-Small Cell Lung Cancer (NSCLC). The American Society of Clinical Oncology honors practices that are dedicated to developing new ways to slow, halt, cure and prevent cancer through clinical research. Today, there are nearly 12 million cancer survivors in the United States, mainly because of the work done in clinical trials. New clinical trials are opened throughout the year. Contact the research office for the most up-to-date availability. The Cancer Center currently has the following clinical trials that are accepting new patients: ■ INCB-MA-PV-401: Prospective Non-Interventional Study of Disease Progression and Treatment of Patients with Polycythemia Vera in United States Academic or Community Clinical Practices (REVEAL). ■ LCCC-001: Randomized, Double Blind, Control Trial Evaluating the Effects of Inhaled Aromatherapy on Nausea and Vomiting in Adult Cancer Patients Receiving Treatment in an Outpatient Cancer Center ■ S0931: The EVEREST study – EVErolimus for Renal Cancer Ensuing Surgical Therapy: Histologically or cytologically confirmed renal cell carcinoma (clear cell or non-clear cell), either Intermediate High Risk or Very High Risk Full surgical resection with negative margins, including removal of all + nodes. No evidence or history of distant metastases Every cancer treatment used today is a direct result of clinical trials and the people who took part in them. That is why it is so important to continue cancer research. 27 EISENHOWER LUCY CURCI CANCER CENTER Eisenhower BIGHORN Radiation Oncology Center Undergoing any type of radiation treatment can be frightening and confusing. That’s why our caring staff takes time to explain what’s happening, answer questions and provide information every step of the way. We’re here to make a difficult situation not just bearable, but better. Monica Khanna, MD, Medical Director, Eisenhower BIGHORN Radiation Oncology Center, consults with a patient. Radiation Oncology Centers are located at the Eisenhower Lucy Curci Cancer Center in Rancho Mirage and at Eisenhower George and Julia Argyros Health Center in La Quinta. Understanding Radiation Oncology Radiation Oncology is a subspecialty of radiology, devoted to the treatment of both benign and malignant conditions. Radiation has been used to treat cancer since the early 1900s. Therapeutic techniques have advanced continuously over the years. Treatments are now available that minimize exposure to surrounding healthy tissue while maximizing radiation dose to the cancer. Treatment Planning Starts with You If your physician decides that radiation therapy is appropriate for you, the first step is to develop a plan for your individual treatment. To ensure the highest level of patient safety and compassionate care, your care team, including Board Certified Radiation Oncologists, oncology trained/certified nurses, oncology certified social worker, radiation therapists, dosimetrist, physicist, registered dietitian and experienced front desk personnel, work collaboratively with your primary physician, surgeon and/or medical oncologist to ensure ease of referral and seamless care, and an individualized treatment plan. External Beam Radiation Therapy (EBT) uses our state-of-the-art linear accelerators to deliver radiation to a precise location within the body. A series of 3-D radiation beams are tailored to the size, shape and location of the tumor or cancer cells. EBT is effective for treating a variety of different types of cancers and is often used in cooperation with other forms of treatment, such as surgery and chemotherapy. Two great locations to serve you. Aggressive treatment, compassionate care. When you or someone you love is facing cancer, it helps to know you have a team of experienced, compassionate medical professionals with access to the most advanced treatment options available. If you have any questions about either the Eisenhower BIGHORN Radiation Oncology Center on campus at the Eisenhower Lucy Curci Cancer Center in Rancho Mirage or at the Eisenhower George and Julia Argyros Health Center in La Quinta, please call 760-674-3600, or visit emc.org/radiationoncology. EISENHOWER LUCY CURCI CANCER CENTER Intensity Modulated Radiation Therapy (IMRT) has been one of most significant innovations in radiation therapy. IMRT uses sophisticated computer technology to create extremely precise and accurate treatment plans with precision and accuracy. The variable beam intensity, which is the hallmark of the IMRT technique, allows the radiation beams to be shaped in ways previously thought impossible. Due to its advanced accuracy, radiation is often delivered at higher doses without increased side effects. This allows us to treat tumors that, even a few years ago, would have been considered untreatable due to their size or proximity to vital, healthy organs. ■ Stereotactic body radiation therapy (SBRT) refers to stereotactic radiation treatments delivered within the body (e.g., lung). A customized plan allows physicians to administer high doses of radiation to the cancer with less treatments, typically one to five weeks rather than several weeks. Aggressive Treatment, Compassionate Care When you or someone you love is facing cancer, it helps to know you have a team of experienced, compassionate medical professionals with access to the most advanced treatment options available. This is what you’ll find at the Eisenhower BIGHORN Radiation Oncology Center. Stereotactic Radiation The surroundings are designed for comfort and tranquility, including our private patient lounges with panoramic windows overlooking the surrounding desert spectacle. Intimate seating and a selection of complimentary refreshments are provided to help patients and their loved ones relax during appointments. Even the treatment rooms feature ceilings that resemble a desert night with a canopy of twinkling stars designed to engage patients during treatment sessions. A specialized type of external beam radiation therapy called stereotactic radiation uses focused radiation beams targeting a well-defined tumor, relying on detailed imaging studies, computerized threedimensional treatment planning and precise treatment set up to deliver a radiation dose with extreme accuracy. There are two types of stereotactic radiation: Beyond the state-of-the-art medical technology and warm, healing environment is a team of experienced and compassionate health care professionals, greeting individuals by name, getting to know them as more than just a patient, making special efforts to break through the “high tech” and provide our patients with “high touch” care, making this a healing place like no other. ■ Stereotactic radiosurgery (SRS) does not actually involve surgery. It is a non-invasive method of delivering a precise dose of intense radiation to a tumor located in the brain. SRS offers an important alternative for many brain tumors, benign and malignant, which have traditionally been treated with invasive surgical methods. Depending on the type of tumor, one or several radiation treatments may be involved. This treatment technique can reach virtually any area in the brain, including those not accessible by conventional surgery. 29 EISENHOWER LUCY CURCI CANCER CENTER Eisenhower Infusion Centers Comprehensive Infusion Services to Help You Regain Your Health Combining Clinical Excellence with Compassionate Care Chemotherapy is the treatment of cancer with powerful medications to destroy cancer cells by stopping their growth and reproduction. Often referred to as “anti-cancer” drugs, they are most often administered intravenously (IV) or by injection or orally. Chemotherapy can be used alone, or in conjunction with radiation therapy or surgery. We understand the challenges, both physical and emotional, that affect every patient and their loved ones. That is why our team of registered nurses are experienced in infusion services, certified in chemotherapy administration and available to provide information and answer questions. Patient and family education is an essential part of your care. We encourage all of our patients to be informed and active partners Biotherapy – treatment to stimulate or restore immune system abilities. Used in various illnesses. Blood transfusions – administration of blood components such as red blood cells and platelets when individuals have low blood counts due to various illnesses. Our nurses’ stations are located in the middle of the Infusion Center, allowing our staff to provide the care and attention necessary while reducing surrounding noise and distractions that may make it difficult for patients to rest and relax. in their treatment and healing process. Whether it is special instructions for taking care during and after treatments, or tips to help reduce unpleasant side effects associated with some infusions, we help treat Intravenous antibiotic treatment – to treat infections. Subcutaneous injections – administration of injectable drugs such as those used to boost production of red or white blood cells, or in anticoagulant therapy. Hydration therapy – infusion therapy to treat dehydration in patients undergoing chemotherapy or persons dehydrated due to insufficient fluid intake. the disease and care for the whole person – our patient. A Place Where Your Needs Come First When you have cancer or another diagnosis that calls for infusion treatment, you can rely on the Infusion Centers at the Eisenhower Lucy Curci Cancer Center to support your care. With seven locations to meet your needs, our team of experienced, caring medical professionals and facilities focused on patient comfort and convenience — we’re here for you. If you have questions about infusion therapy or services available, please call 760-773-1500, or visit emc.org/infusion. EISENHOWER LUCY CURCI CANCER CENTER Uncompromising Clinical Care in a Comfortable Setting When you don’t feel well, the comfort of your home is especially important. From the picture windows to the welcoming smiles of our staff, our Center was designed with you in mind – to make your treatment experience as pleasant and comfortable as possible. The unique environment within our Infusion Centers are complemented by the additional features of the Eisenhower Lucy Curci Cancer Center, such as a tranquil Auxiliary Healing Garden available for strolls in the fresh air, sunlight or personal meditation. All of these details combined create a healing place like no other for our patients. We’ve taken every detail into account to help you feel at home. National Oncology Nursing Certification Makes a Difference ■ Oversized reclining treatment chairs. In both the inpatient and outpatient departments of the Eisenhower Medical Center Cancer Program, oncology nursing care is delivered by nurses with specialized knowledge and skills. Nurses complete additional education and training focused on cancer care. All nursing staff have completed the National Oncology Nursing Society standard chemotherapy and biotherapy training for specialized competency in the handling, administration, and management of chemotherapy drugs and side effects. ■ Pillows and heated blankets. ■ A variety of refreshments are available. ■ Semi-private and private rooms available in most locations upon request and according to individual circumstances. ■ Complimentary Wifi NEW Locations for Infusion Centers There are now seven locations in Rancho Mirage, Yucca Valley, Palm Springs, and our newest Infusion Center at the Eisenhower George and Julia Argyros Health Center in La Quinta, thanks to a generous donation by BIGHORN Golf Club. Many of Eisenhower’s chemotherapy-trained nursing staff have attained a specialized national certification as an Oncology Certified Nurse (OCN), a distinctive certification for qualified and experienced registered nurses, who have demonstrated specialized knowledge in cancer care by meeting specific eligibility requirements and passing a rigorous certification exam. 31 EISENHOWER MEDICAL CENTER BIGHORN Behind a Miracle: Transforming Breast Care Since its inception eight years ago, BIGHORN Behind a Miracle (BAM) has raised more than $5 million for local cancer patients. This year an amazing $600,000 was raised benefiting the Eisenhower Schnitzer/Novack Breast Center, Eisenhower Lucy Curci Cancer Center, and the BIGHORN Radiation Oncology Center. committee members, none of this would have been possible.” BIGHORN BAM executive committee members include Selby Dunham; Debi Aarthun; Cheryl Hall, Golf Tournament Chair; Marie Pinizzotto, MD, and Carol Ammon. In addition to the purchase of new, state-of-the-art breast imaging and ultrasound equipment, funds will continue to support a year of round-trip transportation services for patients undergoing radiation and chemotherapy treatments who would normally rely on public transportation. Through the leadership and dedication of Dunham and the entire BAM committee, and the support of BIGHORN Golf Club members, breast care and diagnostic capabilities at Eisenhower have been transformed. “We are so grateful for the incredible on-going support from BAM, and we thank them for their generosity,” says Laura Fritz, Vice President, Foundation. “BAM members have changed the course of history for Eisenhower. Theirs is a remarkable story of impact, progress and compassion.” “BIGHORN Behind A Miracle has proven to be exactly that...a true miracle,” shares Selby Dunham, BAM founder. “The generosity of the BIGHORN members, our friends and supporters from the Vintage, Toscana, Reserve and Indian Ridge is truly extraordinary....without the enthusiasm and energy of so many volunteers and 32 (Blank inside back cover) 39000 Bob Hope Drive / Rancho Mirage, CA 92270 760-340-3911 / emc.org © 2015 Eisenhower Medical Center 12/15 175