THE TRANSFORMATION OF A CANCER CENTER: A FIVE-YEAR RETROSPECTIVE 2019–2023
THE LEFCOURT FAMILY CANCER TREATMENT AND WELLNESS CENTER
THE LEFCOURT FAMILY CANCER TREATMENT AND WELLNESS CENTER
DIRECTOR’S LETTER FROM Steven T. Brower, MD, FACS
On behalf of my incredibly dedicated colleagues work- ing within The Lefcourt Family Cancer Treatment and Wellness Center at Englewood Health and through- out our community, I am honored to present our can- cer care report for the years 2019-2023. The Lefcourt Family Cancer Treatment and Wellness Center remains steadfastly committed to our mission of providing high-quality, accessible care, and playing a prominent role in our institution’s strategic plan for the next decade. Our goals seek to: 1. Expand our expertise and subspecialty cancer care to more people living within our region 2. Decrease the time from diagnosis to cancer treatment, which translates into more cures and better quality of life 3. Recognize lung cancer as the No. 1 cause of mortality and formulate a clinical program that leads to earlier diagnosis and treatment and im- proved survival 4. Deliver individualized precision cancer care for each patient specific to their disease and biology of the tumor The years encompassed by this report coincide with transformational changes in cancer care that have re- quired us to change the way we deliver services while supporting our patients and families throughout the con- tinuum of treatment and survivorship.
For instance, 2021 saw the largest single decline ever in annual cancer mortality rates in the United States. By 2025, 20 million survivors are predicted with a five-year survival rate of greater than 70 percent. Most of the re - duced mortality is the product of increased early detec- tion and prevention, although advances in treatment for some of our most difficult cancers, such as lung, lympho- ma, melanoma and renal, have benefited from amazing therapeutic advances. The year 2021 commemorated the 50th anniversary of the National Cancer Act. Much of the progress of these past 50 years in cancer research and care has been made possible through this act and the development of the Na- tional Cancer Institute (NCI), my own alma mater. The National Clinical Trials Network, established by the NCI, has contributed to the cure of cancers, led to the de- velopment of life-prolonging adjuvant chemotherapy and radiation therapy for some cancers, and established the importance of patient involvement and advocacy. There is little doubt that the major contributor to declines in cancer mortality over the past five decades has been the reduction in smoking. Other successful risk-reduction strategies have included public health efforts covering hepatitis B and HPV immunizations and screening for cer - vical, colorectal, breast, oral, lung and skin cancers. Here at Englewood Health, we are increasingly diagnos- ing lung cancer at earlier stages, helping to reverse the course of this deadly disease because of an institutional commitment to our low-dose screening CT program.
Another major advance has been the expansion of the Human Genome Project and the Cancer Genome Atlas. These programs have produced a comprehensive de- scription of normal and abnormal human genomes that can give rise to cancer and are the key drivers of many cancers. This has led to a move from a “magic bullet” and generalized approach to targeted therapies and individu- alized medicine, precision and mechanism-based treat- ments that have been successful against some of our most challenging cancers. At The Lefcourt Family Cancer Treatment and Wellness Center, we have embraced molecular medicine with the addition of physician experts and the establishment of mo- lecular tumor boards. We offer what’s called “tumor agnos - tic care,” an innovative approach to cancer treatment that focuses on the genetic and molecular characteristics of a tumor, rather than its specific tissue of origin. Finally, the most compelling and sobering challenge to cancer care that we witnessed during the period of this report was the care of our most vulnerable patients during the COVID-19 pandemic. Englewood Health took meticu - lous steps to ensure patient safety during this time. I am so proud of the entire team working within the cancer center who were diligent in their protection and care of our oncology patients. During the pandemic, disparities in access to health care—particularly among minority and older adults in the nation—became very apparent. It is estimated that mor - tality for individuals who delayed screening for common malignancies during this period will be responsible for an additional 10,000 deaths in the U.S. during the next five
to 10 years. Mortality for our most common cancers in New Jersey, such as lung, prostate, breast and colorectal, remain substantially higher within our Black, Latino and Asian communities. As we celebrate the enormous advances in cancer care made in the last 50 years and in the five years encom- passed by this report, we recognize that we have much more to achieve. Englewood Health is committed to con - fronting cancer with our highest commitment to technol- ogy and compassion, while recognizing our institution’s equally important role in examining and improving soci- etal deficiencies in healthcare determinants. We will con - tinue to perform this important work, as we build toward a world that is one day free from cancer.
Sincerely,
Steven T. Brower, MD, FACS Medical Director, The Lefcourt Family Cancer Treatment and Wellness Center Chief of Surgical Oncology, Englewood Health
2
3
2019-2023 AT A GLANCE
Expansion of Cancer Services
of accreditation from the National Accreditation Program for Breast Centers 14 years
of accreditation as a Comprehensive Community Cancer Program by Commission on Cancer 9 years
new fellowship-trained sub-specialists 16
1,872
42%
2
patients treated for breast cancer*
growth in prostate cancer program**
new breast services locations
214
33%
2
early stage lung cancer diagnoses*
growth in colorectal cancer program**
new imaging centers
6,549
radiation therapy treatments* 40,034
35,948
new cancer patients treated*
chemotherapy infusions*
4
of new clinical space in Fair Lawn 30,000 sqft
70,000+ sqft
new urgent care locations
of new clinical space in Jersey City
* 2019 to 6/30/23 ** 2019 to 2022
4
5
Englewood Health has made a commitment to two power- ful strategies in the fight against cancer. The first is to increase early detection across all major cancers. The second is to reduce the time that lapses between a diagnosis of cancer and interven- tion with cancer treatment (also known as a “time-to-treatment” rate) such as chemotherapy, radi- ation, or surgery. This two-pronged approach is proven to translate into better odds at treatment, more people cured of their cancers, and improved qualities of life after treatment. Importantly, Englewood Health’s average time-to-treatment rate is below the national average. In an effort to detect cancers earlier— when they are most likely to re- spond to treatment—Englewood Health has adopted aggressive screening guidelines and expand- ed access to cancer diagnostics, with new imaging locations in Fair Lawn and Jersey City. Englewood Health also organizes free and low-cost cancer screen- ing events and programs to ensure lifesaving screenings are accessi- ble to the community. These pro - grams aim to reduce the barriers preventing at-risk communities from undergoing screenings; de- tect cancer at earlier stages; and educate individuals about their need for ongoing vigilance. Englewood Health Tackles Cancer in Our Communities
A Pioneering Population Health Strategy These two strategies align with the organization’s overall population health mission. In addition to in - creasing access to quality care and services, Englewood Health pro- vides the health education, screen- ing and prevention activities need- ed to improve outcomes.
As Englewood Health strives to ad- vance health equity across popula- tions, it leverages community health needs assessments, clinical data, and patient demographic informa- tion to inform a targeted approach. The team understands the impact that age, race, gender, socioeco-
nomic status, and other social de- terminants of health can have on health outcomes and actively col- laborates to remove any barriers to the delivery of true, patient-cen- tered care.
The Cancer Center’s Inception and Growth
of new clinical space in Hudson County 70K+ sqft
In 2014, a transformative vi- sion took shape at Englewood Health—a vision centered around establishing a comprehensive, disease-specific cancer care pro- gram that unifies essential ser- vices within a single facility, opti- mizing the delivery of care. What followed was a two-year journey, marked by the recruit- ment of esteemed leaders, the establishment of robust infra- structure, and the expansion of fa- cilities within Englewood Health’s hospital campus. By the close of 2016, this effort materialized into the official nam- ing of The Lefcourt Family Cancer Treatment and Wellness Center. Since then, Englewood Health’s cancer care services have flour- ished, transcending the hospital’s four walls and extending to out- patient sites throughout northern New Jersey. The center’s transformative growth is evident in its team of fellowship-
trained subspecialists, which has surged from 12 to 28. This in - cludes fresh expertise in lung, colorectal, breast, endocrine, gy- necologic, and urologic cancers, among others. Englewood Health has also grown its team of sub- specialized pathologists in lung, breast, and gynecologic cancers, as well as the growing field of mo- lecular pathology. The center has developed a ro- bust infrastructure to support a patient on their unique journey from diagnosis through survivor- ship. This includes genetic and nutritional counseling, patient navigation services, survivorship support and more. Years of strategic expansion and the cultivation of highly special- ized teams have enabled Engle- wood Health to deliver excep- tional cancer care closer to home, bridging the gap between ad- vanced medical expertise and the communities it serves.
new urgent care locations 4
new imaging centers 2
Christos Stavropoulos, MD, director of thoracic oncology at The Lefcourt Family Cancer Treatment and Wellness Center and chief of thoracic surgery at Englewood Health with lung cancer screening team and low dose CT scanner.
6
7
color, with Asian, Black, and Hispan - ic Americans at higher risk for these diseases. In New Jersey, Black men and women have higher colorectal
cancer mortality rates than those of other racial and ethnic groups. With this knowledge as a guiding princi- ple, Englewood Health has made a
an equitable chance to triumph over breast cancer.”
commitment to ensuring screenings for colorectal cancer are as assess- able as possible.
Guidelines Evolve: Breast, Lung, and Colorectal Cancer
Lowered Age Recommen- dation for Colorectal Cancer Screening Reflects Rising Incidence in Younger Individuals In 2021, the U.S. Preventive Services Task Force issued a new recom- mendation that colorectal cancer screening for people at average risk should begin five years sooner—at age 45. A particular consideration within Englewood Health’s cancer strate- gy is the fact that New Jersey has a slightly higher incidence of col- orectal cancer (40.8 vs. 38.4 per 100,000 in the general population) than the nation. This may be due, at least in part, to lower screening rates. Among screening-age adults in the state, 36% of men and 35% of women report not being up to date with current screening guidelines, above the national average of 30%. Much of the colorectal cancer out- reach efforts at Englewood Health have focused on communities of
Recent years have seen a trend in national cancer screening guidelines, with three of the most pervasive cancers (lung, breast and colorectal) seeing their screening recommendations adjusted to include younger people. “The population of patients that we are screening for cancer is evolving,” says Meghan Kaumaya, MD, hematologist/oncologist at Englewood Health. “We’re screening patients for colorectal, breast, and lung cancers earlier now than ever before because the data indicates that many of these cancers are presenting at a younger age.”
Updated Lung Cancer Screening Guidelines Broaden Eligibility for Low Dose CT Scans
Annual lung cancer screening is now recommended to begin for individu- als ages 50-80 with a 20-pack-year smoking history, instead of the previ- ous recommendation of people ages 55-74 with a 30-pack-year history. Englewood Health has seen an in- creasing volume of patients diag- nosed with lung cancer at earlier stages—a direct result of the health system’s investment and expansion of its low-dose screening CT program. In 2011 the New England Journal of Medicine published the landmark findings from the National Lung Screening Trial: a low-dose CT scan of the lungs of smokers was found to detect tumors smaller than previ- ously possible. Prior to this discov - ery, there were few, if any, reliable methods of detecting lung cancer early, when patients had the best chance of successful treatment. “Ten to 15 years ago, saying the words ‘lung cancer’ and ‘cure’ in the same sentence was rare,” said Christos I. Stavropoulos, MD, chief of thoracic surgery and director of tho- racic oncology at The Lefcourt Fam- ily Cancer Treatment and Wellness Center at Englewood Health. “Today, there have been many advance- ments in lung cancer detection and treatment that have greatly impact- ed survival rates.”
an increased mortality rate among Black women, who are 40 percent more likely to die of breast cancer than White women. “It is a stark truth that Black wom - en face a higher risk of experienc- ing adverse outcomes in their bat- tle against breast cancer. Factors such as delayed diagnoses and limited access to quick intervention contribute to this alarming trend,” says Violet M. McIntosh, MD, chief of breast surgery at Englewood Health. “At Englewood Health, we are committed to addressing these disparities so that every woman has
Englewood Health has prioritized bringing low-dose CT scans, as well as the gamut of imaging and radiol- ogy services, into the communities it serves. With the aim of increas - ing participation in these lifesaving screenings, Englewood Health also has a dedicated patient navigator for lung cancer screenings. Christos Stavropoulos, MD, director of thoracic oncology at The Lefcourt Family Cancer Treatment and Wellness Center and chief of thoracic surgery
“This navigator’s objective is to help patients traverse the process of qualifying for, scheduling, and undergoing lung cancer screen- ings,” said Lewis M. Attas, MD, a hematologist and oncologist at Englewood Health. “The goal is to eliminate obstacles that might hin- der patients’ access to this critical screening option.”
Violet M. McIntosh, MD, chief of breast surgery.
Disparities in Outcomes Prompt Change in Mammogram Recommendations
In 2023, the U.S. Preventive Ser - vices Task Force announced new recommendations for breast cancer screening. The recommendations (in draft form, but not expected to change dramatically when finalized) call for women to begin receiv- ing mammograms every two years starting at age 40 if they are at av- erage risk for breast cancer. That’s a significant change from the pre- vious guidance that recommended women should begin mammograms at age 50. This change comes after an in- crease in diagnoses of breast can- cer among younger patients and
growth in colorectal cancer program** 33%
early stage lung cancer diagnoses* 214
patients treated for breast cancer* 1,872
Anna Serur, MD, chief of colon and rectal surgery.
8
9
Englewood Health ZT Systems Outpatient Center at Jersey City
Englewood Health has opened new facilities in Fair Lawn and Jersey City as part of a strategic plan to expand access to vital cancer diagnostics, im- aging, and treatment services. The new facilities, located at 22-02 Broad - way in Fair Lawn and at 2 Journal Square in Jersey City, include full-service diagnostic imaging and breast centers, as well as therapeutics. “Our medical center has undergone a complete transformation as it relates to how we deliver cancer care. We have put forth tremendous resources to extend this care to patients closer to where they live in both Hudson County and western Bergen County,” said Steven T. Brower, MD, FACS, medical director of the Lefcourt Family Cancer Treatment and Wellness Center and chief of surgical oncology at Englewood Health. “With our advanced fellowship-trained specialists, we are bringing a unique level of cancer care into the community.” The imaging capabilities at both locations include: caret-right 3D mammography (tomosynthesis) and stereotactic biopsy caret-right breast ultrasound and core needle biopsy Expanding Diagnostic Access with New Imaging Centers in Hudson and Bergen Counties
Beverly’s Story – Lung Cancer SCAN TO READ
“When I look back now, I’m thankful I got sick that day in church, because it led me to Englewood Health and is the reason I was diagnosed so early on, when the cancer was most treatable.”
10
11
caret-right bone densitometry (DEXA scans) caret-right CT scan (128-slice, low-dose CT) with coronary CT angiography capability caret-right MRI (3-Tesla wide-bore MRI) for breast, whole body, musculoskeletal and neuro caret-right ultrasonography caret-right radiography “Imaging tests, such as CT scans and MRIs, are integral in the early de - tection of cancer, and many of these tumors, if found early, are treatable and curable,” says Mark Shapiro, MD, the chief of radiology at Englewood Health. Mindy Goldfischer, MD, chief of breast imaging and medical director of The Leslie Simon Breast Care and Cytodiagnosis Center at Englewood Health, adds, “When an annual mammogram is made accessible, every - one is more likely to undergo screenings. Having local access to these important breast services saves lives.”
Patient navigation team at The Lefcout Family Cancer Treatment and Wellness Center
Englewood Hospital Imaging at Fair Lawn
Empowering Cancer Patients with Expanded Support Networks
The Lefcourt Family Cancer Treat- ment and Wellness Center at En- glewood Health has expanded the care provided to patients through a dedicated oncology patient nav- igation program. Patient naviga - tors working with The Cahn Family Cancer Care Companion Program at Englewood Health serve as a pa- tient’s direct contact within the can- cer center and help coordinate the patient’s treatment. Nurse navigators also help coordi- nate ongoing physician and special- ist visits, including support for the
emotional and psychological effects of cancer, as well as cancer screen- ings when recommended to ensure patients remain cancer-free. In 2022, Englewood Health estab- lished an Oncology Financial Navi- gation Program. The health system also offers navigators to help cancer patients consult with specialists in physical therapy, occupational ther- apy, integrative medicine, nutrition, and pain management—providers who can help them develop strate- gies to maintain their quality of life as cancer survivors.
12
13
HOSPITAL-WIDE AWARDS & RECOGNITION 2019-2023
Englewood Health Recognized for Excellence in Cancer Care
MAGNET RECOGNITION 5 TIMES SINCE 2002
During the period 2019-2023, Englewood Health was the recipient of various national recognitions for clinical excellence, patient safety, and innovation. Among these achievements, Englewood Health was: caret-right Recognized for excellence in patient care by the National Accredi- tation Program for Breast Centers (NAPBC). The NAPBC once again granted accreditation status to The Leslie Simon Breast Care and Cytodiagnosis Center at Englewood Health, which has been ac- credited since 2009. caret-right Named a Pancreatic Cancer “Center of Excellence” by the National Pancreas Foundation. Englewood Health joined three New Jersey centers and just 154 centers nationwide to achieve this designa- tion. caret-right Ranked as a “high performing” hospital in colon cancer surgery by U.S. News & World Report . Of roughly 6,000 hospitals surveyed throughout the United States, only 450 hospitals achieved high performing status. caret-right Re-accredited as a Comprehensive Community Cancer Program by Commission on Cancer (CoC) of the American College of Surgeons. To earn CoC accreditation, a center must demonstrate high levels of excellence in the delivery of cancer care. caret-right Received the Leapfrog Top Hospital Award, which recognizes ex- cellence in patient safety, quality, and efficiency. caret-right Achieved the highest performance category in the Leapfrog Hospi- tal Survey. caret-right Received Healthgrades’ Patient Safety Excellence Award, placing Englewood Health in the top 10% nationally for safety among Medi- care patients.
LEAPFROG GROUP HOSPITAL SAFETY GRADE “A” - 2019-2023
LEAPFROG TOP TEACHING HOSPITAL 2023
LEAPFROG PANDEMIC HERO OF THE YEAR AWARD 2020
HEALTHGRADES PATIENT SAFETY EXCELLENCE AWARD 2022
14
15
Innovation and Technology
Tracy’s Story – Breast Cancer SCAN TO WATCH
“She dealt with a loved one of hers that had cancer,” Tracy said. “And so, I felt that she understood my side as a patient, as well as her side as a physician.”
16
17
Precision Medicine Catalyzes Change in Cancer Care At Englewood Health, tumor board meetings are held weekly for a wide range of cancers, including brain, breast, colorectal, lung and lym- phoma, among others. In addition, a molecular tumor board meeting is held monthly to review data on the mechanisms of action within differ- ent genetic mutations. Kevin Yao, MD, chief of neurosurgery at Englewood Health, says that the weekly tumor boards allow Engle- wood Health to engage all relevant specialists in giving each patient a comprehensive opinion.
Through the TIME Trial Program, pa - tients whose cancers have not re- sponded to currently approved ther- apies are matched to open clinical studies of novel approaches based on the molecular profiles of their specific tumors. Patients with rare mutations that may not be treatable with currently approved therapies can access these trials and the ther- apies they are evaluating without having to travel elsewhere. “Our understanding of how genetics impact an individual’s predisposition to cancer and their response to treatment has transformed the landscape of oncology. Englewood Health’s commitment to genetics has not only elevated the standard of care we deliver, but also exemplified the power of precision medicine in improving outcomes for our patients.” — Tamar H. Goldwaser, MD medical director of the genetics program at Englewood Health
work, we know that they are at in- creased risk for recurrence,” Mikhail Tismenetsky, MD, a pathologist at Englewood Health explains. “Often, we see these spikes in ctDNA before we see a rise in certain biomarkers or even the presence of tumor on imaging, which means we can iden- tify cancer recurrence earlier and im- prove our patient’s prognosis.” With this data, oncologists at The Lefcourt Family Cancer Treat- ment and Wellness Center can either treat certain patients’ can- cers more aggressively or spare them from therapy that would impair their quality of life when they are unlikely to benefit from it. Englewood Health Investiga- tors Leverage Molecular/ Genetic Testing for Clinical Trial Participant Selection In addition to determining choices of treatment, the molecular signatures of patients’ tumors can also help identify those who may benefit from participation in clinical trials that are evaluating novel therapies—particu- larly agents that are designed to tar- get specific genetic pathways. At Englewood Health, Jill S. Mor - rison, MD, medical director of the hospital’s infusion center, is the prin- cipal investigator of one such trial, which is examining how to improve survival rates in women with specif- ic genetic markers in breast cancer. In addition, the Lefcourt Family Cancer Treatment and Wellness Center at Englewood Health is one of just 50 cancer centers nationally to have partnered with the TIME Trial Program.
Genetic Testing Refines Targeted Therapies in Cancer Care The field of pathology has undergone a change in recent years. In the past, pathologists were concerned about the histology of the specimen, looking at tissue samples and carefully clas- sifying what they saw. “But that only gets you so far,” ex - plains Ana Burga, MD, chief of the Department of Pathology at Engle - wood Health. “Now we are breaking the sample down to the genetic lev- el. If we find a certain mutation, we can use therapies that specifically target cancer cells (or molecular al- terations driving their growth), min- imizing damage to healthy cells and reducing side effects compared to traditional treatments like chemo- therapy.” Today, there is also a wider range of targeted therapies against spe- cific mutations than there were just a few years back, Dr. Burga notes. One example: Poly (ADP-ribose) polymerase (PARP) inhibitors are a group of medications that inhibit a particular enzyme, and their use has been approved for patients with the inherited BRCA mutation, as well as ovarian and other cancers. At En - glewood Health, tumors are tested for HRD (homologous recombina- tion deficiency) which, if detected, can also qualify patients for PARP inhibitors to treat their cancer, even if they do not carry a pathogenic BRCA1 or BRCA2 variant.
the molecular signatures for can- cers in individual patients. At Engle - wood Health, patients who present with stage II and, in some cases, stage III disease (colorectal cancer as well as other cancers with high recurrence rates) undergo what’s called an “Oncotype DX test” to identify the molecular signatures of their tumors. In addition to solid tumor testing, circulating tumor DNA (ctDNA) test - ing is utilized to evaluate molecular signatures unique to individual pa- tients’ tumors to determine their risk for recurrence. Results from ctD- NA tests can help guide treatment planning such as the need for che- motherapy after surgery. “If we see a spike or increased num - ber of ctDNA in a patient’s blood
“With this wide range of exper - tise, we can optimize the treat- ment plans for our patients and ensure they are receiving the best possible options,” he notes. Molecular, Genetic Testing Support Precision Medicine for Colorectal Cancer Molecular pathologists at Engle- wood Health are analyzing tissue samples collected from resected colorectal tumors and pinpointing
Tumor boards offer a platform for ensuring consistent evaluation related to diagnosis, treatment, symptom management, follow-up, and supportive care. These tumor board members share ideas on op- timal management, then pass this information on to the patient and their caregivers so that they have a better understanding of their dis- ease and treatment journey.
Breast cancer tumor board meeting
18
19
Latest MRI Technology Enables Earlier Detection of Cancer At Englewood Health, investments in the most advanced technology available today have enabled critical progress in precision imaging, and thus, the earlier diagnosis of cancer. One such investment was the pro- curement of a 3-Tesla (3-T) MRI machine, which doubles the clarity of images and resolution over the 1.5-T MRI machine, which was pre - viously used. This new MRI technology can de- tect smaller lesions and anatomic structures. With the 3-T MRI ma - chine, images are generated fast- er, so patients do not need to stay inside the scanner for as long. The machines themselves are also not as physically confining as previous renditions of the technology. “That’s important,” says Mark Sha - piro, MD, chief of radiology at En- glewood Health. “The chance that a patient will remain still and reduce the possibility of a motion artifact is better with these MRIs, and that supports our ability to make an ac- curate diagnosis.” Englewood Health now has four 3-T MRI machines, covering both inpa- tient and outpatient imaging needs. This technology is available on the hospital campus, as well as its im- aging sites in Fair Lawn and Jersey City. Englewood Health’s effort to bring advanced diagnostics into commu- nities—along with its team of sub-
py to treat liver cancer. During ra - dioembolization, tiny glass or resin beads filled with the radioactive iso- tope yttrium Y-90 are placed inside the blood vessels that feed a tumor. “The volume of patients treated with Y-90 has grown significantly,” says Allison Barone, MD, an inter - ventional radiologist at Englewood Health, “particularly in recent years.” The radiation from the Y-90 beads damages the tumor cells while spar- ing healthy liver tissue surround- ing the cancer. This procedure can support the treatment of liver can- cer by improving symptoms and slowing down disease progression, especially in cases where surgery is not possible. “Patients experience few side ef - fects from this treatment, which can extend and improve their quality of life,” adds Dr. Barone.
specialty train radiologists whose expertise is in the detection of spe- cific cancers—is leading to earlier diagnoses and improved prognoses. Interventional Radiologists Elevate the Treatment of Liver Cancer At Englewood Health, a team of in- terventional radiologists works with the cancer center to ensure pa- tients have access to all available treatment options. This close col - laboration enables patients with the most advanced cancers to engage in novel treatments that improve their quality of life. An excellent example of this is the growing reliance on radioemboli- zation to treat cancers of the liver. Radioembolization is a minimally invasive procedure that combines embolization and radiation thera-
Eliana’s Story —Thyroid Cancer SCAN TO READ
“I was immediately thinking: will I need surgery, radiation, or chemo? By that time, there had been so much cancer in my family. I think I suffered from having too much information.”
20
21
Innovations and Transformations in Cancer Care
PRE-ADMISSION COUNSELING/ PATIENT ENGAGEMENT
The assessment consists of a com- prehensive evaluation of the patient’s function, physical performance, co- morbid medical conditions, medica- tion routine, social support, nutrition- al status, and cognition. Older patients who are candi- dates for chemotherapy undergo a 90-minute evaluation that includes these and other components prior to starting treatment. The goal is to ensure that patients who may need additional interventions designed to optimize outcomes receive them. “Historically, people over 65 have not been enrolled in clinical trials, so we don’t have robust data on how they tolerate chemotherapy. Hence it is exceedingly important to assess their tolerance prior to administra- tion of chemotherapy,” says Minaxi P. Jhawer, MD, chief of hematology/
oncology at Englewood Health and associate medical director of The Lefcourt Family Cancer Treatment and Wellness Center. She adds, “By evaluating patients with this comprehensive geriatric assessment, we can identify health factors that influence outcome. This in turn gives us an opportunity to address these factors prior to che- motherapy and improve overall out- come of our patients”. A New Approach to Supporting Lung Cancer Patients After Surgery Christos Stavropoulos, MD, director of thoracic oncology at The Lef- court Family Cancer Treatment and Wellness Center and chief of tho- racic surgery at Englewood Health, says that the initiation of a new postoperative protocol has great- ly improved the experience of lung cancer patients. The protocol is called enhanced recovery after surgery (ERAS). The thoracic oncology program now uses the ERAS regimen, a detailed algorithmic flow that guides pa- tients through the entire periopera- tive period.
AUDIT OF COMPLIANCE/OUTCOMES
FLUID AND CHO-LOADIN/ NO FASTING
Holistic Method Enhances Care for Geriatric Patients The Lefcourt Family Cancer Treat- ment and Wellness Center at En- glewood Health is taking a holistic approach in the assessment of old- er patients with advanced cancers. The goal is to identify more accu- rately those who may benefit from systemic therapy, as well as those who may require additional interven- tions to achieve optimal outcomes. According to the most recent guide- lines from the American Society of Clinical Oncology, in patients age 65 years and older receiving che- motherapy, a “geriatric assessment” should be used to identify potential vulnerabilities or impairments that may affect treatment outcomes.
EARLY REMOVAL OF CATHETERS
NO PREMED
PREVENTION OF NAUSEA AND VOMITING
NO NG TUBES
ERAS Enhanced Recovery After Surgery
PERIOPERATIVE ORAL NUTRITION
SHORT-ACTING ANAESTHETIC AGENT
NON OPIATE PAIN MANAGEMENT/NSAIDS
AVOIDANCE OF SODIUM/FLUID OVERLOAD
EARLY MOBILISATION AND RESPIRATORY PHYSIOTHERAPY
MINIMALLY INVASIVE SURGERY, ONE DRAIN
WARM AIR BODY HEATING DURING PROCEDURE
The ERAS regimen is based on ex- tensive research and guides best practices, both for the physicians and patients, to reduce the patient’s surgical stress response, optimize their physiologic function, and facil- itate recovery. “I am proud of the fact that we have a very comprehensive approach to taking care of these patients, from entrance to exit, and back to home,” Dr. Stavropoulos says. Patients with Thyroid Cancer Benefit from Personalized Techniques Englewood Health’s thyroid cancer team has found success in identi- fying potentially malignant thyroid nodules using a unique approach. Patients with nodules that meet the
American College of Radiology’s Thyroid Imaging Reporting and Data System criteria for “suspicious” (i.e., possible cancer) are recommended for a fine-needle aspiration (FNA) biopsy. Samples collected during the FNA are immediately evaluated by pa- thologists at chairside. In addition to standard diagnostic criteria, samples also may be submitted for molecular testing to identify thyroid gene alterations. “With this approach, we are better able to identify nodules and per- form ultrasounds and fine-needle aspiration biopsies,” says J. Thomas Chon, MD, medical director for thyroid cancer, Englewood Health Physician Network. Englewood Health thyroid surgeons use a more individualized strategy that considers a person’s risk for re-
currence. “The goal is to make sure that a patient gets through surgery safely, and gets surgery only if they need it,” says Ki Won Kim, MD, an endocrine and general surgeon at Englewood Health.
Minaxi P. Jhawer, MD, chief of hematology/oncology
chemotherapy infusions* 35,948
Dr. Ki Won Kim
22
23
Changing the Face of Surgical Intervention
see, as well as the most malignant. Historically, surgeons have used technologies such as intraopera- tive MRI, ultrasound and/or CT for guidance during the removal of complex tumors. However, in the case of glioblastomas, where mar- gins are small and require precision due to surrounding tissue, fluores- cence guidance—a recent addition to Englewood Health’s armamen- tarium—has proved most effective. For procedures using this ap- proach, the fluorescent compound is administered orally two to four
hours prior to the induction of an- esthesia. Essentially, it causes cancerous tissues to “glow in the dark,” explains Kevin Yao, MD, chief of neurosurgery at Englewood Health. “Bathing them in bright pink, fluorescent light enables sur- geons to clearly differentiate the cancer from surrounding cells and structures. “When you look at these tumors with the naked eye, much of the tu- mor tissue looks like normal brain. This can make resection very chal- lenging for surgeons and potential-
ly leave patients with devastating deficits postoperatively,” he adds. “Fluorescence guidance enables us to remove more cancerous tis- sue without compromising normal tissue.”
Englewood Health expanded its ro- botic surgery program with the ac- quisition in 2023 of a third da Vinci Surgical System—the robotic plat- form from Intuitive Surgical. The da Vinci robot is the most advanced platform for minimally invasive surgery available today. This technology acts as a natural extension of a surgeon’s eyes and hands, while offering enhanced dexterity and visualization of pa- tients’ anatomy. At Englewood Health, this fourth generation da Vinci technology (the Xi model) accommodates an increasing volume of robotic cas- es, as well as a growing number of robot-certified surgeons across colon and rectal, gynecologic, uro- logic, and thoracic surgery. The health system’s robotic volume has increased over 200% since 2017, when Englewood Health had just one da Vinci surgical system. With the use of the da Vinci robot, Maz Ganat, MD, chief of urology at Englewood Health, performs increasingly complex urologic on- cology procedures, including par- tial and radical nephrectomies for kidney cancer and radical cystec- tomies for bladder cancer. “The Xi is an excellent tool to allow us to continue to provide great care to our patients,” he says, “There is much better vision and mobility for surgeons and faster recovery for patients.” Anna Serur, MD, chief of colon and rectal surgery at Englewood Health, agrees. “For me, the Xi is
like driving a new-model Porsche,” she says. “It is a much better piece of equipment.” Dr. Serur now does oncologic re - sections almost entirely robotically and reports that these patients nor- mally stay just one to two days in the hospital and return to normal activ- ities within one to two weeks. The reduction in postoperative pain is a significant advance and, according to Dr. Serur, very few patients require narcotics during their recoveries. Christos Stavropoulos, MD, director of thoracic oncology at The Lefcourt Family Cancer Treatment and Well- ness Center and chief of thoracic surgery at Englewood Health, says that robotic surgery eases the post- operative course, particularly for pa- tients of advanced age. “In the past, an elderly patient who is frail would not be cleared for a major lung resection,” he says. “But now, because we can do the procedure robotically and very minimally inva- sively, we can operate on this type of patient, and they have good results.” In all these surgical endeavors, the reduction in bleeding from the use of robotic technology is central to En- glewood Health’s focus on bloodless surgery. “We haven’t needed blood transfusions, which allows for a bet- ter and quicker recovery,” Dr. Stav - ropoulos notes. The health system’s early adoption and expansion of robotics has been recognized by Intuitive Surgical, which designated Englewood Health as one of two gynecologic and gy- necologic oncology case observa- tion sites on the east coast.
Fluorescing tissue “lit up” by Gleolan™ facilitates maximal and safe removal of glioma cells from brain tissue during surgery.
Robotic surgeons from specialties in urology, bariatric surgery, colon and rectal surgery, thoracic surgery, gynecology and gynecologic oncology, and endocrine and general surgery.
Nimesh Nagarsheth, MD, medical director of gynecologic oncology and robotic surgery at Englewood Health, has been named a key opin- ion leader by the company. “What that means is surgeons from around the U.S. come to observe our program, watch us operate and learn how we efficiently arrange our patient workflow,” said Dr. Nagar - sheth. “These visitors are seeking to replicate our model at their insti- tutions. When it comes to robotics, Englewood Health is recognized as a regional and national leader.”
Brain Tumor Removal Enhanced by Fluores- cence-Guided Surgery
The Lefcourt Family Cancer Treat- ment and Wellness Center at En- glewood Health is using the latest image-guided technology in the re- section of glioblastomas, the most common type of brain tumor they
24
25
Reuben’s Story – Prostate Cancer SCAN TO READ
Englewood Health is helping to define new standards of care in radiation oncology. The health system’s radiation oncology team is a leader in the adoption and integration of advanced technologies to provide exceptional patient care. An Advanced Approach to Radiation Oncology “At Englewood Health, we are using technology to support the expertise and acumen of our disease-specific oncology teams and, together, we are refining treatments and improving patient experience and outcomes,” says David Dubin, MD, chief of radiation oncology. “As radiation therapy evolves, newer technologies provide greater opportunity to minimize side effects and complications through increasingly improved precision in treating tumors of every location and size.”
“He prepared me step-by-step for everything that I would eventually experience. He would say, ‘after this many weeks, you’ll feel like this,’ and it would all happen. Everything fell into place exactly as he said it would.”
26
27
Englewood Health Delivers Targeted Precision in Radiation Therapy Englewood Health is delivering greater precision in radiation oncology us- ing its expertise in surface guided radiotherapy (SGRT), enabled by the newest VisionRT AlignRT® system. SGRT enables the treatment team to detect and track a patient’s 3D sur- face (skin) in real time to ensure accurate positioning and continuous pat- ent monitoring throughout treatment. Continuous tracking of the patient is used to ensure that radiation is delivered accurately and can account for all patient motion, including normal breathing. This is especially beneficial, for example, for breast cancer patients. According to Violet Merle McIntosh, MD, chief of breast surgery, Englewood Health’s breast cancer teams have shortened the course of radiation therapy for many breast cancer patients. VisionRT’s AlignRT technology is an application for SGRT that uses ste - reoscopic vision to continuously monitor a patient’s skin surface, tracking thousands of points in real-time to refine positioning throughout radiation treatment. For patients, this innovative advancement also eliminates the need for permanent tattoos placed on patient’s body as guideposts for radiation delivery. For advanced gynecologic cancers, Nimesh Nagarsheth, MD, director of gynecologic oncology and robotic surgery, notes that metastatic cervi- cal and uterine cancers, which sit close to the bladder and rectum, can be treated with greater precision and higher intensity, allowing for shorter treatments because of this advanced technology, while reducing injury to surrounding structures. Englewood Health’s level of expertise in performing SGRT using Vision - RT’s AlignRT has earned national recognition. In 2021, Englewood Health’s radiation oncology team was selected to present its clinical expertise on the use of SGRT for Deep-Inspiration Breath Hold to the National SGRT Conference. Radiation and Surgical Oncologists Join Forces to Optimize Outcomes Englewood Health is at the forefront of pioneering advancements that enable more adaptable treatment plans in radiation oncology. Now with the addition of MIM Maestro software, radiation oncologists can directly incorporate all rel- evant medical imaging into the treatment process, enabling them to monitor and refine the delivery technique throughout a patient’s course of treatment. At Englewood Health, patients benefit from multispecialty disease-specif- ic teams that work harmoniously to assure optimal outcomes. Using this
advanced technology, our teams are minimizing risks for side effects of radiation therapy, such as incontinence and impotence, for the primary or secondary treatment of prostate cancer says Maz Ganat, MD, chief of urol- ogy and program director for Urologic Oncology. MIM Maestro’s deformable registration aligns two or more three-dimen- sional (3D) images into one unified frame. By merging images, radiation oncologists gain the ability to monitor subtle changes in organ shape, size, and position throughout the course of treatment. “Traditionally, radiation oncology relied on a single plan for the entire course of treatment, tailored to each patient’s unique condition at the time of di- agnosis,” says Michael Speiser, Ph.D., chief physicist at Englewood Health. “However, throughout the treatment journey, things change, such as a pa - tient’s weight or a reduction in the tumor volume.” Today, even for complex plans, physicians and physicists can efficiently access and evaluate data and harness that information to generate new plans based on current information, instead of relying on an established single plan for the entire treatment course.
David Dubin, MD, chief of radiation oncology and Michael Speiser, Ph.D., chief physicist
28
29
For example, Anna Serur, MD, chief of colorectal surgery, notes that for late-stage cancers, radiation therapy may be used to reduce the size of the tumor prior to surgery and allow for organ preservation, avoiding the sur- gery entirely, or doing more limited resection. Some patients may undergo post-surgical radiation to eliminate any residual cancer cells that may exist in the margins. With more accurate technology, and a commitment to min - imizing complications and precisely treating the tumor, Englewood Health’s colorectal cancer team is shortening the course of treatment and reducing side effects that posed greater risks in the past. MIM Maestro allows for treatment comparison by enabling enhanced pa- tient image registration and contouring, and ease of comparison between previous treatment and current state of disease. In turn, the software equips radiation oncologists, in collaboration with medical and surgical on- cologists, to adapt treatment plans as the course of therapy progresses. This approach means more efficient and accurate treatment plan prepara-
tion and treatment evaluations, ensuring that oncologists can effectively target the entire cancer while sparing healthy surrounding tissue at every stage of treatment. Radiation Effects vs. Tumor Regrowth: New Imaging Technique Refines Assessment Neuro-oncologists at Englewood Health are one of few in the region using a new imag- ing protocol called high-resolution contrast clearance analysis. The protocol takes data derived from conventional 3D contrast-en-
radiation therapy treatments* 40,034
hanced MRI and provides neurosurgeons with additional insight into tumor characteristics, enabling more accurate assessment of radiation effects versus tumor regrowth, which can look similar after cranial radiation. This enhanced visual data now informs treatment decisions for patients with glioblastomas and other brain tumors. “One of the challenges we run into with treatment of malignant brain tu - mors is that the treatment, whether it be surgery, radiation or chemother- apy, often leads to changes in the brain that render MRIs uninterpretable, meaning we can no longer differentiate between treatment effects and tumor regrowth,” says Kevin Yao, MD, chief of neurosurgery at Englewood Health. “Contrast clearance analysis makes our decision-making process clearer, by enabling us to differentiate between the effects of treatment and regrowth accurately.”
Kimberle’s Story – Colorectal Cancer SCAN TO WATCH
At age 51, Kimberle was diagnosed with colorectal cancer for the third time. After seeking several opinions, she opted for genetic testing and found the best course of treatment for her at Englewood Health. Feeling confident in her future, Kimberle says of the Englewood Health team, “You don’t just feel like you’re being cared for just your illness, you feel like you’re being treated as a person.”
30
31
Several of Englewood Health’s physician leaders have penned clinical guidelines for cancer care or are currently sitting on national guideline committees that are drafting clinical pathways for cancer. Steven T. Brower, MD, FACS, medical director of The Lefcourt Family Can - cer Treatment and Wellness Center and chief of surgical oncology at En- glewood Health, asserted, “Being chosen for these committees validates that our cancer center has nationally recognized leaders in the specific cancers we treat, whether that be colorectal, liver, pancreatic, or stomach cancer.” caret-right Dr. Brower sits on the program committee for the American Hepato- Pancreato-Biliary Association, as well as the constitution and bylaws committee of the Society of Surgical Oncology. Dr. Brower is a for - mer Associate Board member for the American Cancer Society’s Hope Lodge in New York City. caret-right Anna Serur, MD, chief of colon and rectal surgery at Englewood Health, has been a member of the rectal cancer committee of the American Society of Colon and Rectal Surgeons since 2018. The committee in - cludes leading colorectal surgeons tasked with establishing guidelines for the treatment of colorectal cancers and creating a path with which to assess surgical capability. caret-right Minaxi P. Jhawer, MD, Englewood Health’s chief of hematology/oncol - ogy and the associate medical director of The Lefcourt Family Cancer Treatment and Wellness Center, co-authored a clinical guideline— published 2020 Journal of Clinical Oncology: The use of systemic therapy in patients with advanced hepatocellular carcinoma. caret-right Minaxi Jhawer Co-authored: Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Thera - py: ASCO Guideline Update. Journal of Clinical Oncology, Published online July 17, 2023, and 2019. caret-right Dr. Jhawer is served on the ASCO clinical practice guidelines committee which sets guidelines for treatment and management of cancer. caret-right As members of the ASCO’s Supportive Care Guidelines Commit- tee, Vinnidhy Dave, DO, director of palliative medicine at Englewood Health and Dr. Jhawer are helping to develop and update guidelines to support the physical, psychological, and social needs of patients and their families. They have developed a clinical trial which addresses medications to improve weight loss in cancer patients. Englewood Health Physician Leaders Pen Cancer Care Guidelines
SHAPING THE FUTURE
Steven Brower, MD
Anna Serur, MD
Minaxi Jhawer, MD
Vinnidhy Dave, DO
32
33
Page 1 Page 2-3 Page 4-5 Page 6-7 Page 8-9 Page 10-11 Page 12-13 Page 14-15 Page 16-17 Page 18-19 Page 20-21 Page 22-23 Page 24-25 Page 26-27 Page 28-29 Page 30-31 Page 32-33 Page 34-35 Page 36-37 Page 38-39 Page 40Made with FlippingBook interactive PDF creator