Cancer Care Today
Comprehensive Medical Centers Close to Home
It’s official. Cancer will overtake heart disease as the world’s top killer in 2010. By 2030 global cancer cases and deaths should more than double. In Connecticut, cancer is the second leading cause of death, accounting for about one-fourth of all deaths each year.* Chances are someone in your circle has been affected—a forty-something soccer mom struck down in her prime by breast cancer; a fun-loving father of two sidelined by colon cancer; a kindly neighbor stunned by the discovery of a deadly tumor on her pancreas.
When the diagnosis is cancer, your first thoughts might run to big-name cancer hospitals like Memorial Sloan Kettering in New York or the Dana Farber Cancer Institute in Boston. But Fairfield County patients don’t have to travel so far to receive state-of-the-art cancer care. Connecticut is home to an expanding roster of excellent, comprehensive cancer centers that offer a full complement of diagnostic, treatment and support services. The growth in local cancer centers is consistent with the size of the problem, observes Stuart G. Marcus, M.D., senior vice president and chairman of oncology at St. Vincent’s Medical Center. He says, “I don’t look at the multitude of cancer centers as competition, but rather of acknowledgment of this devastating problem. Working together, we will be able to provide cancer care of the highest quality throughout the state and allow patients the choice of staying close to home, where they belong.”
But local cancer hospitals do compete. Many have ramped up their programs, recruited top surgical specialists, invested in high-tech diagnostic imaging, radiation and surgical equipment and created serene, spa-like spaces and pampering services to attract more patients. The upshot? The bar is raised, and residents are reaping the rewards.
Yale Cancer Center and Smilow Cancer Hospital at Yale–New Haven
In 2004 Yale–New Haven Hospital set tongues wagging when it proposed Smilow Cancer Hospital, a $465 million building for patients at the hospital and Yale Cancer Center—Connecticut’s only National Cancer Institute–designated Comprehensive Cancer Center and only one of 40 such centers in the United States. The designation means that Yale is the place where cancer treatments are developed and first used for the treatment of cancer. New therapies are discovered and researched in Yale’s science labs, and, after rigorous testing, used to treat cancer patients from “bench to bedside.”
The hospital opened in October. It’s a state-of-the-art, 14-story, 500,000-square-foot architectural feat that includes 112 inpatient beds, outpatient treatment rooms, expanded operating rooms, infusion suites, diagnostic imaging services, therapeutic radiology, a specialized Women’s Cancer Center and the Yale–New Haven Breast Center/GYN Oncology Center. A large and all-encompassing cancer center, Smilow integrates all oncology patient services at Yale–New Haven Hospital and Yale School of Medicine in a building specifically designed for treating the disease.
“Now you can see your doctor, get an MRI, go for treatment or testing and even stop at Starbucks, all by riding the elevator,” says Lynn D. Wilson, M.D., M.P.H. professor, vice chairman and clinical director of the Department of Therapeutic Radiology at Yale School of Medicine. Collaboration between nationally and internationally renowned scientists and physicians at Yale University Cancer Center and Yale–New Haven Hospital allows the Center to develop the treatments that are later used as standard care both at Yale and at other cancer hospitals.
“The center has enabled us to actively recruit more world-class clinicians and enhance our specialties to provide more depth and more clinical trials, and to really personalize our services,” Dr. Wilson notes. “With a multidisciplinary approach, our team will know all there is to know about an individual lung-cancer patient, for example, so that we can create an entirely different treatment plan for a lung-cancer patient that we see at 10 a.m. than for another at 3 p.m.”
Team efforts to treat a painfully raw foot wound that would not heal were a godsend for James Wiser, a WWII veteran who lives in Southport. For six years he limped from doctor to doctor in acute pain. When he turned to Yale Cancer Center, he finally got answers and relief. “Dr. Peter Heald brought in a room full of dermatologists to look at my foot,” he recalls. He was diagnosed with cutaneous lymphoma
and started radiation treatments with Dr. Wilson. The pain stopped and the wound healed. “The doctors and staff were really wonderful,” says Wiser, who has returned to his passion of building model ships. “They gave me my life back.”
Yale Cancer Center is also creating a world-class research facility on Yale’s West Campus to focus on groundbreaking cancer studies. Dr. Thomas Lynch, Jr., director of the Yale Cancer Center and physician-in-chief of the Smilow Cancer Hospital at Yale–New Haven, says, “Our doctors and researchers will be studying the biology of each person’s cancer and taking a closer look at genetic mutations. Finding what’s wrong in the genes will allow us to design better, more personalized therapies.”
St. Vincent’s Hospital: The Elizabeth Pfriem SWIM Center for Cancer Care
St. Vincent’s new 125,000-square foot, Elizabeth Pfriem SWIM Center for Cancer Care in Bridgeport opens in January 2010. The four-story building is attached to the hospital and will offer comprehensive, multidisciplinary cancer care. Says Susan L. Davis, R.N., Ed.D., president and CEO, “No one will ever have to travel outside of their home community to secure state-of-the-art cancer care.”
“We are elevating the standard of Cancer Care in Connecticut, especially in Fairfield County,” echoes Stuart G. Marcus, M.D., senior vice president and chairman of oncology at St. Vincent’s Medical Center. “We will be able to offer a wide variety of sophisticated treatments, including access to Phase II and III clinical trials, closer to our community.” In the past, patients had to go to major city hospitals to participate.
Another big enticement is its high-tech treatment options. “We will be introducing to Fairfield County revolutionary technology in radiation therapy with our new Novalis Tx Radiosurgery Program and RapidArc radiotherapy technology. There is only one other program in Connecticut with this level of radiation treatment sophistication.”
“The Novalis Tx Radiosurgery is a painless, noninvasive outpatient procedure for cancerous and noncancerous conditions of the entire body,” says Radiation Oncologist Christopher Iannuzzi, M.D., vice chair of the department of oncology. “It uses a treatment beam contoured to the exact shape of your tumor, precisely delivering treatment while protecting surrounding healthy tissue. And a treatment session lasts just minutes, not hours. This gives new hope to patients with tumors once considered untreatable.”
Complementing the Novalis is the RapidArc radiotherapy technology, a new form of image-guided, intensity-modulated radiation therapy (IMRT). Image guidance improves tumor targeting, and IMRT shapes the radiation dose so that it conforms closely to the three-dimensional shape of the tumor. This means more dose to the tumor, less to surrounding healthy tissue. “RapidArc quickly delivers a complete IMRT treatment with a single rotation of the treatment machine around the patient,” says Dr. Iannuzzi. And the RapidArc is fast: A treatment is delivered in less than two minutes.
As in many of the newer cancer centers, the medical oncologists, radiation oncologists and surgeons will have their offices in the center, so patients will be able to receive a comprehensive treatment plan often within a single visit.
Also, a full floor will be dedicated to breast services with entirely digital mammography equipment, ultrasound and state-of-the-art biopsy techniques.
A wide range of counseling, support and integrative services, such as meditation, help with the emotional effects of cancer. Marcus says, “Our chemotherapy suites open to a healing garden where patients can sit outside and enjoy the plantings, open sky and natural light.”
Help also comes from St. Vincent’s SWIM Across the Sound, a charitable, grass-roots organization run by St. Vincent’s Medical Center Foundation. It provides cancer education, screening and prevention programs at low or no cost for the elderly and underserved. Also, it helps cancer patients on a case-by-case basis with specific needs, such as the funding of wigs and prostheses, medication assistance, and support groups. Dr. Marcus says, “The center will also offer mammography screening in a beautiful, 39-foot mobile coach—essentially a mammography office on wheels.”
To help cancer patients after treatments, Yale Cancer Center, St. Vincent’s Hospital’s SWIM Cancer Center and Stamford Hospital’s Bennett Cancer Center partnered with Connecticut Challenge (ctchallenge.org) to create survivorship programs and clinics. Patients who have completed treatment receive ongoing medical care, nutritional and lifestyle guidance and emotional support. Says Executive Director Bob Mazzone, “We started survivorship clinics as a resource at Yale Cancer Center, but soon realized that we needed to expand….We’d love to have all 30 Connecticut-based hospitals involved. Survivorship is a part of the cancer care continuum.”
Whittingham Cancer Center at Norwalk Hospital
The Whittingham Cancer Center is known for its comprehensive, compassionate care, putting patient and family needs above all else. Here, survivorship programs abound, including a program for cancer patients’ children and a unique patient/family support group. Recently, a forty-one-year-old man with colon cancer attended the patient/family support group with his spouse, and later brought his son and daughter to the children’s program. The children explored questions, concerns and fears about their dad’s cancer, while their parents learned coping skills and communication strategies to help guide the family through the experience.
On the medical side, Whittingham provides access to Phase I clinical trials (the earliest stages of testing new therapies) and trials from the National Cancer Institute and pharmaceutical/biotech companies worldwide. “This enables our patients to undergo new treatments years before they become available to others,” says Dr. Richard Frank, director of cancer research.
Access to the sought-after clinical trials is a strong draw. “It is common for someone to seek a clinical trial at a larger center, only to learn that we are offering the same ones,” says Dr. Frank. To underscore the point, he cites the case of a seventy-year-old man with aggressive prostate cancer growing in his bones and liver, who received an experimental chemotherapy study nearly two years ago at Whittingham that was not available elsewhere. The disease came under rapid control; he has been off anticancer therapy for over a year.
“Our doctors often work collaboratively with bigger centers, especially if a patient has a rare cancer or requires highly specialized surgery. Drs. Zelkowitz and Zahrah [of the Smilow Family Breast Center] attend weekly breast cancer meetings at Memorial Sloan-Kettering, Drs. Pathare and Contessa are on staff at Yale; all of us have a wide network of expert colleagues with whom we frequently communicate about challenging cases.”
When Dr. Frank arrived at Whittingham, he was a “hard-core academic physician” planning to stay forever at Sloan-Kettering. He says, “That was before I had my epiphany and found this jewel of a cancer center, brimming with humanity.” He sums up the spectrum of services. “We recently had a thirty-nine-year-old woman newly diagnosed with breast cancer. She saw the oncology nurse clinician for education about upcoming treatment and was then referred to the image consultant to discuss hair loss and wig options. Later, she met with the psychosocial clinician to learn about our support, and then she scheduled regular sessions for the offerings of gentle massage and reiki.”
WCC doles out a powerful therapy: Hope. “When someone is diagnosed with an incurable cancer, we encourage them to look around the WCC and bear witness to the fact that every patient is unique,” Frank explains. “Our center is filled with patients who have lived many years beyond their initial prognosis. The environment of the center can only be described as electric, buzzing with the personalities of our patients and staff who create a uniquely cheery, humanistic atmosphere. At the same time, we are honest with our patients so that they and their loved ones can be prepared in case the outcome is not what we all hope for. With our many support groups for patients, families and their young children, even when times are rough, there is still room for hope. We encourage it at all levels. Hope is a powerful force that we never take away.”
The Bendheim Cancer Center, Greenwich Hospital
Greenwich Hospital physicians and cancer care staff treat patients at both the inpatient oncology unit located in the Watson Pavilion and at the Bendheim Cancer Center, the hospital’s outpatient diagnostic and treatment facility.
The jewel in the crown, says Maria Marini, R.N., program director, is the hospital’s breast center, headed up by renowned breast surgeon Barbara Ward, M.D., formerly of Yale–New Haven Hospital. It attracts roughly 1,000 new patients a year from all over the Northeast and beyond. “Our patients have access to nationally recognized breast surgeons and plastic and reconstructive surgeons skilled in the latest innovations,” says Dr. Ward, the center’s medical director. Located one floor above the Bendheim Cancer Center, the Breast Center enables women to immediately access all the center’s resources, including digital mammography, the most advanced technology available to detect breast disease.
“We are proud to be on the cutting edge,” says Marini. “We’ve been at the forefront of treating cancer for seventeen years. We’re always looking for the latest innovations, such as our new Prone Breast Radiation Scanner. The difference is that this scanner allows patients to lie face down on a soft contoured surface that places the breast in a cupped position so that it doesn’t move. This lets us diagnose and radiate a tumor in a very precise location without pain or discomfort while sparing surrounding tissue.”
To make things a little less frightening for a newly diagnosed patient, a dedicated nurse navigator is on hand to coordinate all aspects of care. Marini explains, “She meets you after the diagnosis and helps you with steps A, B, C and D, so you can concentrate on getting better rather than on dealing with insurance company hassles or running around to appointments. Her job is to answer your questions, be your sounding board and to make your care and appointment scheduling as easy and as stress-free as possible.”
Under the medical direction of Dickerman Hollister, Jr., M.D., cancer patients receive sophisticated treatment at Bendheim on an outpatient basis, which is a new trend that allows patients to get their treatments without a hospital stay.
Smilow Family Breast Health Center at Norwalk Hospital
The Smilow Family Breast Health Center offers education and support for women as they cope with abnormal findings—whether malignant or benign.
Medical Director Dr. Richard Zelkowitz, a nationally recognized expert in the treatment of breast cancer, oversees the center. His team works collaboratively with the most respected, board-certified doctors, radiologists and surgeons in the state, as well as medical and radiation oncologists and other highly qualified healthcare specialists. The staff address breast care in a seamless manner, beginning with screening and rapid diagnosis and continuing with the ongoing support through the center’s breast health specialist.
This dedicated nurse clinician provides the personal support and experience to help new patients navigate the often-confusing healthcare system.
The center’s support services provide answers for breast cancer patients and their families from those who have been there. The center has an area that offers special products for people undergoing cancer treatment.
Carl & Dorothy Bennett Cancer Center at Stamford Hospital
Stamford Hospital is widely known for its high-tech innovations for cancer patients, including CyberKnife, the most advanced radiation treatment in the region. The image-guided robotic surgery system enables physicians to perform radiosurgery on tumors anywhere in the body with minimal risk to surrounding tissue.
Additionally, the hospital is able to provide external beam therapy to tumors using its linear accelerators. The Bennett Center’s accelerators are unique. “Ours is equipped with Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) capabilities,” explains Liz Manfredo, M.S., R.D., director of cancer services. “This advanced mode of radiotherapy delivers precise radiation doses to a malignant tumor or specific areas within the tumor.”
The Bennett Cancer Center, located on the hospital’s main campus, provides a full range of coordinated services. Though celebrated for its high-tech equipment, it is also known for its distinctive garden atrium, with a soothing waterfall and cushy waiting areas.
There’s a big emphasis on helping patients and family de-stress. Says Manfredo: “We offer our patients support groups as well as reiki, reflexology and massage at no charge. Many choose to schedule an appointment prior to treatment so they can relax and, sometimes, our integrative-medicine practitioners will visit patients while they are undergoing treatment. Families and patients can also benefit from our ongoing sound and music therapy workshops in the soothing environment of the atrium.”
Ambience aside, the physicians are all specially trained and remain current on the latest cancer therapies and minimally invasive surgical procedures. In addition to radiation therapy and chemotherapy, they offer a full array of clinical trials. If rare or unusual cancers are diagnosed, their physicians have open lines of communication with oncologists nationwide to whom patients can be referred.
Breast cancer survivor Linda Chriscoe of Stamford says, “When I was considering where to go for my treatments, the most important things were convenience, being comfortable with my doctor and trusting that my doctor had the right empathy for me as an individual. I thought it would be best if my treatments were where I live.”
Manfredo concurs, saying, “We feel strongly that patients should not have the added stress of traveling long distances to receive excellent care.”
Norma F. Pfriem Breast Care Center
The Norma F. Pfriem Breast Care Center, celebrating its tenth anniversary with updated facilities, is the first freestanding community breast care center in the state. “We’ve helped 18,000 women since 1999,” says Executive Director Donna Twist, Ph.D. “Many women prefer not to travel to a hospital for surgery and treatment. They are more at home at a community-based center, where they feel like they are surrounded by family and can meet with their doctors and access all services, from treatment to counseling, under one roof.”
The center has the largest and most extensive genetic risk-assessment program in Fairfield County, teaching women like Madonna Sacco, who has a hereditary risk of breast cancer, about testing options that can help them make decisions about reducing their risk of developing the disease. Sacco, a member of the Breast Care Center’s President’s Council, was not aware of her family history of breast cancer. But, on a trip to Italy, she learned of her history on the paternal side of her family. (Women with the BRCA mutation have a 60 percent chance of developing breast cancer, compared with 12 percent in the general population, and a 15 percent to 40 percent risk of ovarian cancer, compared with 1.4 percent in the general population).
She returned to the Breast Care Center for genetic testing and discovered that she was positive for the BRCA mutation. So she “dug deeper” to ward off the possible return of her cancer. “I realized that not all the care in the world would make a difference,” she says. Sacco had a prophylactic mastectomy and hysterectomy, reducing her risk of breast and ovarian cancer. “Essentially, the Breast Care Center saved my life twice,” she says. “They gave me all the information I needed, but left the decision to me. It was much easier to make up my mind after getting the information.”
The center provides a comprehensive network of services at two locations: Bridgeport Hospital, 267 Grant Street, Bridgeport, and 111 Beach Road, Fairfield. The staff is available to teach patients about breast self-examinations, advise them about an unusual lump and provide a full range of cancer treatments and support.
Their mantra is that women deserve help through the emotional and physical stress of cancer treatment. They place a major emphasis on creating a sense of well-being and “the kind of support and understanding that can only come from people who have been through it themselves,” Twist explains. To that end, there are massage therapies, programs like “Look Good, Feel Better” and workshops for caregivers and partners. “When patients feel good about themselves and know they have the support of their loved ones,” says Twist, “the breast cancer journey is much less stressful.”