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
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