LEADERSHIP > VISION > INNOVATION

Cancer Care at Stony Brook University Hospital

2005 ANNUAL REPORT

CANCER CARE AT STONY BROOK UNIVERSITY HOSPITAL ANNUAL REPORT 2005 LEADERSHIP MESSAGE

Bruce Schroffel, CEO and director, Stony Brook University Hospital John S. Kovach, MD, director, Long Island Cancer Center Theodore G. Gabig, MD, chief, Hematology and Oncology; deputy director, Long Island Cancer Center and chair, Cancer Committee

Everywhere at Stony corporates tranquil areas for patients and Our Brook University their families, easy access and ample park- ing. While modern facilities and state-of- mission Hospital there is is to the-art equipment are integral to provid- evidence of change, ing advanced cancer care, there is no re- provide growth and progress. source more important than those individ- excellence uals who care for patients, research new in patient The hospital marked its 25th anniversary therapies and seek cures. In our journey by taking stock of the past and paying toward attaining National Cancer Institute care, homage to all that has made it strong and designation as a comprehensive cancer education, sound. This milestone coincides with our center, we have recruited physicians who The leadership team in front of the forging ahead with a master plan that will are highly respected experts in their Ambulatory Care Pavilion, under construction. research propel the hospital to a new level of promi- fields, many of whom offer unique servic- and nence. Expansion, enhancement, rebuild- es and innovative techniques; specially bench to bedside and, ultimately, new or community ing and innovation is apparent at every trained oncology nurses; and committed improved methods of patient care. turn, with centers of excellence a main and dedicated researchers. Contents service. focus of our commitment. We look for- The feature stories in this report share Leadership Message...... 1 ward to the next twenty-five years as we As Long Island’s premier academic med- the experiences and challenges faced by Clinical Care...... 2 ascend to new heights both on national ical center and level-one trauma center, patients and healthcare professionals and international levels, and we continue 2.8 million residents look to Stony Brook alike, and give us pause to reflect on the Advanced Laparoscopic Techniques...... 9 to fulfill our mission of excellence in pa- to deliver the most up-to-date therapies. human side of cancer. We invite you to Community Outreach...... 25 tient care, education, research and com- The recently expanded Bone Marrow read about a surgeon who not only uses Standing Strong for First Responders ...... 26 munity service. Transplant Unit allows for both autolo- an innovative surgical technique but also gous and allogeneic transplants, while a Clinical Support ...... 29 teaches it to others. You will learn what is Nowhere is our effort more apparent than newly equipped radiation oncology unit being done to monitor the health and well Research...... 32 in the area of cancer care and research. provides experts with the ability to per- being of our neighbors and friends, those Super-Potent Aspirin...... 35 We eagerly await the opening of the new form both stereotactic radiosurgery and first responders who put their lives on the Quality and Standards...... 38 Ambulatory Care Pavilion in spring 2006. radiotherapy to treat a variety of tumors; line during and following the events of The 65,000 square-foot facility, designed and, with the new 3-Tesla magnetic reso- September 11. And, you will meet a re- Site-Specific Reports...... 41 to provide seamless delivery of a multi- nance imaging unit, physicians can work markable physician/scientist who has Statistics...... 44 tude of services, will house the Long with the most powerful and highly ad- taken a common drug and developed it Island Cancer Center, consisting of the vanced imaging tool available. into something “super,” showing great Carol M. Baldwin Breast Care Center; promise in treating a form of cancer that outpatient medical, surgical and pediatric Research efforts continue in earnest as is on the rise. We are on a path that is tak- oncology services; state-of-the-art imag- the hospital and the Long Island Cancer ing us to an ever-higher level of investiga- ing services, pain management services Center participate in prominent national tion, discovery and progress, where inno- and cancer support services and a cancer- studies, community-based projects and vation is the order of the day—and where based clinical trials office for the latest in laboratory research. The integration of hope for the future is grounded in the StonyBrookHospital.com research protocols. Recognizing that care the activities of clinical and basic scien- smart medicine and expert care found at extends beyond the clinical, the design in tists continue to strengthen, allowing for a Stony Brook University Hospital. more rapid movement of discoveries from 1

Clinical CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS Hematology and Oncology Care

he Division of Hematology and Oncology neoplastic growth in many tumor types. For this Lung Cancer offers a comprehensive program in cancer reason, a number of inhibitors of various intercel- Program leaders are treatment and research. The new division lular signal transduction pathways are under clini- Evaluation Theodore Gabig, MD, T is the result of the consolidation, effected by its cal therapeutic evaluation. The division partici- division chief; Stefan Center Madajewicz, MD, PhD, leader, newly recruited chief, Theodore Gabig, MD, to pates in several of these early (phase I) and Gastrointestinal and Neuro- help build the collaborative clinical and research more advanced (phases II and III) trials with the Oncological Malignancies; efforts of physicians within the previously named Eastern Cooperative Oncology Group (ECOG) Noshir DaCosta, MD, leader, and the National Surgical Adjuvant Breast and Breast Cancer Management; Divisions of Neoplastic Diseases and Hematology. Kenneth Zamkoff, MD, dir- In addition to physicians and researchers who are Bowel Project (NSABP) as well as through agree- ector, Blood and Marrow experts in their fields, the division includes nurse ment with some pharmaceutical companies. Stem-Cell Transplant practitioners, chemotherapy-certified oncology he Lung Cancer Evaluation Center (LCEC) as radiofrequency ablation are also offered and Program; Douglas Gladstone, provides comprehensive programs to diag- in the near future, computer-guided stereotactic MD, associate director, nurses, and research nurses. Several investigator-initiated clinical trials are Blood and Marrow Stem- being evaluated for the treatment of prostate, T nose and treat patients with lung cancer. radiosurgery will be available. Cell Transplant Program The Blood and Marrow Stem-Cell Transplant breast and colon carcinomas and highly malig- People with x-ray abnormalities that may repre- and director,Autoimmune Program was expanded with the opening of nant astrocytomas, utilizing novel combinations sent lung cancer and people with a known diag- Stony Brook’s growing focus on cancer care has Disease and High-Dose resulted in the acquisition of a positron-emission Chemotherapy; Janice Lu, the Bone Marrow Transplant Unit in 2004. of inhibitors with chemotherapy. In collaboration nosis of lung cancer can undergo evaluation by a MD, PhD; Wen-Tien Chen, Specialized services include autologous and with the Department of Neurosurgery, Stony multidisciplinary group of specialists that include tomography (PET)-CT fusion imaging scanner, PhD, director, Metastases allogeneic bone marrow transplantation for Brook is one of very few centers in the world prac- pulmonologists, a thoracic surgeon, medical on- the latest in technology for noninvasive diagnosis Research Laboratory; Nabil ticing blood/brain barrier disruption, the goal of cologists and radiation oncologists. Pathologists, and staging, as well as state-of-the-art equipment Hagag, PhD, scientific direc- leukemia, lymphoma and multiple myeloma tor, Blood and Marrow Stem- and high-dose chemotherapy for autoimmune which is to enhance delivery of chemotherapy to a Dr. Bilfinger and radiologists and a nurse coordinator provide ex- in diagnostic radiology, interventional bronchos- Eileen Zaoutis, RN Cell Transplant Program; diseases. The unit houses seven private, specially brain tumor while maintaining cognitive function. pert additional support. copy and radiation oncology. These technologic Patricia Hentschel, NP, MS, di- in the OR designed rooms with state-of-the-art equipment advances support an active program in thoracic rector, Cancer Clinical Trials Specialists work as a team in all aspects of diag- surgery, which remains the focus of treatment Office; Dorothy Boll, RN, and infection control systems. Hematology/Oncology nosis and treatment to develop an individualized of lung cancer with curative intent. Procedures Outpatient Services Unit; The Inpatient Oncology Unit maintains 26 regular management plan based on the newest develop- performed include pneumonectomy, lobectomy, Jeannie Gaspard, RN, nurse and four high-dose chemotherapy/transplantation ments in lung cancer screening, noninvasive diag- VATS lobectomy, wedge resection, thoracoscopy manager, Medical Oncology and mediastinoscopy. The mortality associated and Blood and Marrow Stem- beds. The Outpatient Cancer Clinic provides nosis and staging, neoadjuvant treatment strate- Cell Transplant Program; expert oncology nursing and chemotherapy gies, diagnostic and therapeutic bronchoscopy with procedures done at the hospital has been Emily Locher, RN, OCN, for about 10,000 patient visits annually. A new and resectional therapy. consistently lower than the reported national coordinator, Leukemia/ average of between three and five percent. State- Lymphoma Bone Marrow Outpatient Oncology Center with expanded ca- Transplant Service; Michelle pacity for multidisciplinary patient care will open Lung cancer is the fastest growing cancer in the of-the-art techniques in bronchoscopy, including Stevens, MS, NP,AOCNS, co- in May 2006. Current clinical trials include treat- US with over 170,000 new lung cancers diagnosed transbronchial needle aspiration with onsite ordinator of the ment for prostate, breast and colon carcinomas, Program leaders are Thomas yearly. Although the prospects for cure of later pathology, cautery, laser, brachytherapy, and Leukemia/Lymphoma V. Bilfinger, MD, director of the glioblastoma multiforma and aggressive malig- stage lung cancer remain slim, dramatic progress stenting for nonsurgical diagnosis and staging, Marrow Transplant Service Lung Cancer Evaluation Center as well as palliation are also available. and Joanne Maynard,ANP, nant astrocytomas. and interim chief, Division of is being made in early detection, risk assessment Outpatient Services Unit. Cardiothoracic Surgery; Daniel by markers, noninvasive staging and combined Research in the division includes the development Baram, MD, pulmonologist; modality therapeutic approaches. These advances Patients treated at Stony Brook can participate in Theodore Gabig, MD, medical provide the opportunity to more accurately stage ongoing protocols in every phase of diagnosis and of a system for detection of new cancer markers oncologist; Alan Meek MD, and for isolating cancer cells circulating in the patients prior to operative intervention. As a re- treatment, including national studies through the Dr. DaCosta visits radiation oncologist and Eileen sult, treatments such as neoadjuvant chemothera- Eastern Cooperative Oncology Group and the blood. Aberrant signal transduction through re- with a patient Zaoutis, RN, nurse coordinator. ceptor tyrosine kinases is a pivotal event driving py prior to resection, which offer significant prom- American College of Surgeons Oncology Group. ise, can be offered. Advanced technologies such 2 3

CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

Pediatric Child Life Oncology Program

he Division of Pediatric Hematology/ dren with leukemia or lymphoma have been re- he Child Life Program addresses the emo- Oncology continues to be an integral part ported by Dr. Parker and colleagues. In addition tional and developmental needs of patients T of cancer care offered at Stony Brook to these activities, Dr. Yasar Celiker has recently T cared for in the Pediatric Hematology/ University Hospital. Annually, approximately 35 joined the faculty bringing his expertise in brain Oncology Division in both the ambulatory and children with childhood tumors are diagnosed tumors and clinical research to Stony Brook. the inpatient units. There are four supervised and treated at Stony Brook University Hospital, playrooms filled with a variety of games, toys, and representing approximately 50 percent of the Since inception of the Pediatric Oncology arts and crafts. The program embraces the theo- Program in July 1991, approximately 400 children, Program leaders are Robert children diagnosed in Suffolk County over this ry that play is a fundamental element of a child’s I. Parker, MD, director; Yasar time period. As a member of the Children’s adolescents and young adults with malignant growth and development. It provides play as an Celiker, MD; Edward Chan, Oncology Group patients are provided access to tumors have been cared for. The distribution of opportunity for the child to engage in everyday MD; Devina Prakash, MBBS, cancer clinical trials sponsored by the National cases is representative of cases seen across the childhood activity and to help reduce anxiety. MD; Marian Evinger, PhD; Margaret Bayard, RN, CCRC; Cancer Institute. These patients are enrolled in country. Follow-up data for patients continues to Through the use of guided imagery, relaxation Debra Giugliano, MS, CPNP; clinical trials investigating therapy, causes and demonstrate a raw survival rate of over 75 percent and distraction techniques, child life specialists Jeannie Greenfield, MS, biologic characteristics of childhood cancer. and disease-specific survival rates at or above work closely with the patient, family and medical CPNP; Patricia Losquadro, published national rates. High-dose myeloablative team to facilitate coping skills and help support RN; Rosemary A. Mahan, MS, CPNP and Theresa Manning- This has been a year of growth and change for chemotherapy with hematopoietic stem-cell sup- the patient during invasive procedures or proce- Carter, MS, CPNP. the division. Clinical volume has remained high port continues to be utilized for high-risk patients, dures that may be painful. Preoperative teaching with patients with childhood cancers accounting with success. For referral of those few children and medical play are offered for many procedures for approximately 4,000 of the 6,100 total patient who require allogeneic bone marrow transplanta- Dr. Parker and treatments to help prepare the child and fami- examining a encounters provided by the Pediatric Hematol- tion, relationships with regional and national bone ly for the experience and to foster a general young patient ogy/Oncology Division this past year—1,800 as marrow transplant centers have been forged. understanding of the illness. Finally, the Child inpatients and 2,200 ambulatory. The Pediatric Life Program collaborates with the medical team Hematology/Oncology inpatient unit once again Patient and family “non-medical” needs are met and local schools to help set up tutoring, if need- received the highest patient satisfaction rating of through involvement of child life specialists, clini- ed, and to provide a comprehensive school re- any nursing unit in the hospital validating the cal psychologists, social workers, nutritionists and entry program tailored to the class and situation. dedication and hard work of the staff. Treatment spiritual support personnel. The Parent Support The child life specialist and pediatric nurse practi- planning and administration is multidisciplinary Group, “Our Little Heroes,” and specialized tioners educate students and staff at the child’s involving radiation oncologists, pediatric sur- sibling and bereavement programs are offered has been met with enormous enthusiasm in school to facilitate understanding, sensitivity geons and surgical sub-specialists. through the Pediatric Oncology Program. Since school districts across Long Island. Annually, the and acceptance of the child and the illness, thus these support services are not available else- program staff has contact with virtually all of the easing the transition back to school. The division’s laboratory research efforts have where on Long Island, they are open to all Suffolk school districts in Suffolk County and makes 20 to expanded with the recruitment of Dr. Edward County families including those receiving their 25 in-school presentations each year. This service treatment at other institutions. Chan whose research focus is on defining and un- is offered to all school districts on Long Island Program leaders are Samantha derstanding the abnormal biochemical pathways free of charge. Expanding community support for Guijarro, BA, CCLS; Bradley Jerson, in neuroblastoma and similar childhood cancers. The division’s School Re-entry Program contin- the Pediatric Oncology Program is visible in the CLS and Paulette Walter, MEd, CCLS. The molecular genetics of childhood brain tumors ues to grow and to receive both regional and form of increasing contributions to and involve- continues to be investigated by Dr. Marian national recognition. This individualized program ment in the Sunrise Fund, a philanthropic fund Evinger and her team, and new insights into the educates school personnel and students about the established to provide financial support for the causes of abnormal bone mineralization in chil- nature of their classmate’s cancer and therapy and program (www.sunrisefund.org)

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CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

Radiation Oncology

he mission of the Department of Radiation available to support the bone marrow transplant radioiodine ablations for thyroid cancer were Program leaders are Oncology at Stony Brook University program. Stereotactic radiosurgery and stereotac- performed, 31 prostate implants were performed Allen G. Meek, MD, chair and clinical director, tic radiotherapy are provided on a recently in- and 24 radiosurgery procedures were completed. T Hospital is to use state-of-the-art methods to Radiation Oncology; treat patients in a respectful, compassionate and stalled linear accelerator with a special Brainlab Wyman A. Bethune, MD, effective manner; to educate healthcare profes- micromulti-leaf collimator. Brachytherapy is de- The department’s educational mission is focused Radiosurgery Program; Bong S. Kim, MD, clini- sionals in the practice of radiation oncology; to livered either interstitially, intracavitarily, orally, primarily on the training of radiation therapists cal director, Brookhaven pursue knowledge about the practice and science intravenously or surface. Radioimmunoglobulin and medical dosimetrists in coordination with the National Laboratory of radiation oncology and to develop innovative administration is coordinated with medical oncol- School of Health Technology and Management. Radiation Therapy approaches in its application; and to serve as a re- ogy and nuclear medicine. Radiation-dose plan- This popular program graduated eleven therapists Facility; Tae L. Park, MD, Prostate Brachytherapy gional resource for education about radiation on- ning options include two-dimensional, three- and six dosimetrists this past academic year, and Program; Lawrence E. cology and the diseases it treats. In accomplishing dimensional conformal or intensity modulated, its graduates are very successful in finding desir- Reinstein, PhD, director, this four-part mission, the department supports depending on the patient’s need. A CAT scanner able positions. The department is developing a Division of Medical Stony Brook University Hospital’s strategic objec- unit dedicated for radiotherapy planning has just residency in medical physics in collaboration with Physics; Kevin Seely, RTT, director of been installed in the department facilitating the the Department of Radiology and is considering tive to become the regional designated institution Medical Radiography; for cancer care services in Suffolk County. sophisticated treatment-planning program. a residency program in Radiation Oncology. Marybeth Tusso, RN, Amifostine radioprotection is available and is ad- Faculty in the department participates regularly nurse clinician; Edward S.Valentine, MD, Staff of Stony Brook University Hospital, Stony ministered by nursing staff. Nutritional and social in the several multidisciplinary tumor boards at Southside Outreach Brook University’s School of Medicine, The work support are also available. The department the hospital. Program; Xiao-Hong Research Foundation of New York and Stony recognizes that, as stated in the strategic plan Wang, PhD, associate Brook Radiation Oncology P.C. work as a team for cancer services at Stony Brook University The research mission of the Department of director, Clinical Medical Physics; to pursue the department’s mission. This team Hospital, “The therapeutic clinical program is of Radiation Oncology is clinically focused, including Tamara E.Weiss, MD, includes six physicians, four PhD physicists, four utmost importance to the success of the cancer the development of software and hardware to ad- Pediatric Program and medical dosimetrists, fifteen radiation therapists, program, because it provides the primary attrac- vance radiation treatment techniques, participa- High-Dose Rate ten nurses and nursing assistants, six administra- tion of patients to the program.” To this end, the tion in clinical trials through several cooperative Brachytherapy Program and Maureen Zagami, department intends to continue to operate the groups, and the development of investigator-initi- tors and sixteen clerical/secretarial staff. Staff MPA, administrative provides services at two sites, Stony Brook Radiation Oncology Program at the highest level ated pilot trials of new techniques or applications. director. University Hospital and Brookhaven National of technological ability and patient satisfaction. The department’s clinical research mission is ex- Laboratory, during normal daily working hours, pected to expand in the coming year with an en- as well as an on-call basis at the hospital during From July 2004 to June of 2005, there were 928 hanced focus on clinical trials supports and the fa- evenings and weekends. new consults at Stony Brook and Brookhaven cilitation of translational research. National Laboratory. The five leading diagnoses Clinical services provided include evaluation and were breast cancer, prostate cancer, lung cancer, The Department of Radiation Oncology is com- management services for patients with cancer and thyroid cancer and gynecologic malignancies. mitted to helping lead the effort to make Stony related radiotherapy and supportive procedures. Fifty-four percent of the referrals were from Brook the designated institute for cancer care Radiotherapy procedures available include exter- community-based physicians and 46 percent services in Suffolk County by continuing to nal-beam radiotherapy from single- and dual-ener- were from Stony Brook full-time faculty. A total demonstrate operational efficiency and compe- gy linear accelerators and low- and high-dose rate of 20,256 external-beam radiotherapy treatments tency, enhance interdisciplinary communication, Dr. Meek and the brachytherapy. The external beam radiotherapy were provided, 98 low-dose and high-dose rate be therapeutically innovative and broaden our newly installed linear can be delivered via either conventional or inten- brachytherapy procedures were performed, 87 education and clinical research programs. accelerator for stereo- tactic radiosurgery sity modulated beams. Total body radiotherapy is and stereotactic radiotherapy

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CANCER CARE AT STONY BROOK UNIVERSITY HOSPITAL ANNUAL REPORT 2005

ADVANCED LAPAROSCOPIC TECHNIQUES HELP PATIENTS REGAIN HEALTH

Three people from It was then that Mr. Lukas was introduced three to five small incisions, one-half to to David Rivadeneira, MD. A board-certi- one-inch long, called “ports.” In laparo- different back- fied colorectal surgeon, Dr. Rivadeneira scopic colon surgery, at the very begin- grounds, at very dif- recalls that he was initially drawn to the ning of the procedure, carbon dioxide gas field because, as he puts it, “most patients is inflated into the abdominal cavity to ferent stages in their do well and the prognosis is usually help create more space. A laparoscope, lives and, seemingly, good.” Faced with the prospect of two sur- which is a device attached to a camera geries, one to repair the hip and another that sends images to a video monitor, is with very little in to remove the cancer, Mr. Lukas is ex- inserted into one of the ports. The other common—little, that tremely grateful for healthcare profession- ports accommodate instruments used in als who truly performed as a team. “I was the course of the procedure. As Dr. is, other than a life- impressed by the way the doctors spoke Rivadeneira explains, “What makes the threatening disease with each other, so that everyone knew laparoscopic technique for colon surgery what was going on, and that as the patient, particularly challenging lies in the fact and a surgeon whose I was a part of every decision,” he says. that unlike operating on an appendix or skills with a laparo- The decision was made to repair Mr. gall bladder, where the area is relatively Lukas’ hip prior to scheduling him for the confined and small, the average colon is scope helped each colon surgery, which would be performed eight-feet long, lies within the entire ab- of them to regain by Dr. Rivadeneira. domen, and rather than being situated or localized within one area, spans multiple their health and During the course of his fellowship at quadrants. As an area of surgery, it is reclaim their lives. the Lahey Clinic in Burlington, Mass- measured not in inches, but in feet.” achusetts, and surgical training at New York Hospital-Cornell Medical Center and Dr. Rivadeneira is quick to point out that Eighty-one-year-old Irwin Lukas was Memorial Sloan-Kettering Cancer Center, laparoscopic surgery is not really mini- hospitalized at Stony Brook University Dr. Rivadeneira received specialized train- mally invasive, as is often touted, but Hospital last spring after falling at home ing to perform colorectal surgery laparo- rather is a “minimal-access” surgery. “It and breaking his hip, an unfortunate scopically. While laparoscopic surgery is important to emphasize that this is not event that just may have saved his life. had become almost commonplace for minimal surgery,” says Dr. Rivadeneira. During his hospital stay it was discovered such things as gall bladder, appendix, “Patients receive the exact same cancer a variety of gynecologic conditions and operation they would get with open sur- David Rivadeneira, MD, with Rachel Catan and Irwin Lukas orthopedic repairs, laparoscopic surgery gery.” Compared to open surgery, inci- for colorectal conditions, including malig- sions are much smaller, recovery is much nancies, is fairly new and technically quicker, and patients experience much that Mr. Lukas had previously suffered a demanding. less pain. Where traditional surgery usu- heart attack. A catheterization confirmed ally requires a hospital stay averaging five that the attack was minor and that sur- Traditional surgery usually involves mak- to eight days and recovery at home last- gery was not necessary at the time. How- ing an incision large enough to expose the ing six weeks or more, patients having la- ever another test determined that Mr. area, allowing surgeons ample access to paroscopic surgery can expect a hospital Lukas had colon cancer, something that work. Using the laparoscopic technique, stay of two to four days and can return to would require surgery. the surgeon instead makes, on average, work as early as two to three weeks. A

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ADVANCED LAPAROSCOPIC TECHNIQUES CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS HELP PATIENTS REGAIN HEALTH

landmark multi-institutional study pub- “He put me at ease and made me feel I had the utmost faith in him, and his Surgical lished in the May 2004 issue of The New comfortable during a pretty stressful training and experience were very im- England Journal of Medicine suggested time,” she says. She was particularly pressive.” In November 2003, Rachel had Oncology that the laparoscopic approach is an attracted to the benefits of laparoscopic surgery to remove the cancer. The type acceptable alternative to open surgery surgery—less pain, less hospital and of surgery she had often requires a for colon cancer and demonstrated that recovery time, and equally important to colostomy, either temporary or perma- he Division of Surgical Oncology provides patients had less pain, a decrease in this young woman, less scarring. nent. “I was happy and relieved that Dr. comprehensive surgical expertise for pa- narcotics use and were able to return Rivadeneira was able to remove the T tients with cancer. The expertise of a strong to daily routines more quickly. Sandra’s condition required the removal cancer completely without performing faculty is available to children and adults with can- of her entire colon, followed by chemo- open surgery—and in a way that made a cers of the gastrointestinal (GI) tract, including Mr. Lukas was well aware that laparoscop- therapy and additional surgeries. She colostomy unnecessary,” says Rachel. upper GI malignancies (esophagus, stomach, ic procedures are “the wave of the future” has nothing but good things to say about Soon after the surgery she watched from liver, bile ducts and pancreas), carcinomas of the and had no hesitation about having his Stony Brook University Hospital, the the sidelines as her son, then a senior in colon and rectum, and malignant melanoma and surgery performed in this way. Upon laparoscopic procedure, and her surgeon. high school, played in a playoff football sarcoma. Pioneering techniques and promising awakening in the recovery room, he “Everyone helped to take good care of game. Head of Children and Parents’ research are greatly advancing care to patients recalls being shocked by how small the me. Dr. Rivadeneira has got it all. He is a Services at a large bustling public library, with GI cancers. These include new and powerful incisions actually were, especially since great surgeon with advanced skills, who Rachel attended her staff’s holiday party imaging technologies that help surgeons remove he had approximately one foot of his colon knows how to treat his patients, both in a in early December, just a month after disease and spare vital tissue, the availability of removed and two sections joined together. medical sense and on a personal level.” It the procedure, returned to work soon endo-rectal ultrasound, magnifying endoscope After weathering some health issues unre- has been just two years since her journey after, and began chemotherapy in January. and laparoscopic surgical techniques. The divi- lated to the colon surgery, Mr. Lukas says began, but Sandra is doing well, back to Rachel follows up regularly with Dr. sion has recently welcomed oncology surgeons he is functioning “at almost 100 percent,” work, and looking forward to the future. Rivadeneira, and she is encouraged by Kepal Patel, MD, Colette Pamijer, MD, and breast cancer and malignant melanoma. Since the and is home with his wife, continuing to her most recent test results. William Smithy, MD. division has a number of members who have an enjoy retired life. A lengthy recovery and prolonged ab- Program leaders are Martin expertise in sentinel-node detection, active clini- sence from work was not something Relatively few surgeons across the coun- Karpeh, MD, chief, Surgical Patients with malignancies arising in the head cal work is being conducted. Unlike Irwin Lukas, Sandra Lanning’s Rachel Catan had time for. Two years ago, try are offering laparoscopic colon sur- Oncology; Thomas Bilfinger, and neck region receive care through the MD, interim chief, Cardio- bout with colon cancer came as no at the age of 41, the spirited and youthful gery to their patients. That may change in thoracic Surgery; Brian Division of Otolaryngology. Surgeons at the Surgeons in the Division of Surgical Oncology are surprise—despite the fact that she was mother of two teenaged children was di- the not too distant future because when O’Hea, MD, director, Carol hospital’s Carol M. Baldwin Breast Care Center partners of more than fifty protocols activated by diagnosed at age 28. Familial polyposis agnosed with cancer after a routine physi- he is not seeing patients or in the OR, M. Baldwin Breast Care provide leading-edge surgical techniques for the hospital’s Institutional Review Board. Many Center; Martyn Burk, MD, syndrome, a condition where literally cal indicated a need for follow-up testing. much of Dr. Rivadeneira’s time is spent patients with breast cancer. different disease sites with experimental treat- PhD; Marvin Corman, MD; thousands of polyps grow inside the colon A colonoscopy revealed that she had teaching this highly specialized technique Colette Pameijer, MD; Kepal ments, including breast cancer, colon cancer and and, if left untreated, practically guaran- rectal cancer. “ ‘Cancer’ was the last thing to other physicians. Many physicians are Patel, MD; David Treatment for cancer involves a multimodality melanoma, have been examined. The Surgical tees that those with the hereditary dis- I expected to hear,” she recalls. “I’m rela- traveling long distances to learn, and Dr. Rivadeneira, MD; Maisie approach using surgery as well as chemotherapy Oncology Division participated in the National Shindo, MD; William Smithy, ease will develop colon cancer before tively young and I was feeling just fine. Rivadeneira’s classes are full. “I have and radiation. The Division of Surgical Oncology Institutes of Health-funded research projects on MD.Thomas Lee, MD; Cedric reaching the age of 40, led her to undergo Besides, with a family, two dogs and a full- trained surgeons from in and around the Priebe, MD; and Richard works closely with Hematology/Oncology and consent for tumor bank tissues. Clinical research genetic testing. After determining that time job, I couldn’t imagine being laid up immediate area and from as far away as Scriven, MD, Pediatric Radiation Oncology Divisions to design and includes the American College of Surgeons Oncol- she carried the gene, a colonoscopy and for any length of time.” While waiting for Mexico, Turkey and Singapore,” he says. Surgery. implement new protocols for the treatment of ogy Group research protocols, as well as affiliation biopsies revealed that surgery was neces- an appointment at a major New York “I love teaching and sharing my knowl- various tumors. New techniques in laparoscopy with the Eastern Cooperative Oncology Group sary and should be done as quickly as cancer center to obtain a second opinion, edge and am convinced that within the now afford less invasive surgical alternatives for (ECOG) and other national cooperative groups. possible. Sandra’s sister-in-law, Kim Rachel found her way to the “new special- next ten years, if not sooner, the laparo- some select patients with abdominal malignancies Lyktey, an oncology research nurse ist” on staff at Stony Brook University scopic technique will be the standard for and colon and rectal cancers. Treatment for can- working at Stony Brook, told Sandra Hospital. “Within hours of consulting with colon surgery. Being at the forefront of cer now includes sentinel lymph node biopsy for about “a great doctor” skilled in laparo- Dr. Rivadeneira, I cancelled my appoint- using this innovative technique is excit- scopic colon surgery. After an initial meet- ment at the other hospital and scheduled ing—but the best part is knowing how ing, Sandra was immediately struck by the laparoscopic surgery,” she says. “His much it benefits patients.” Dr. Karpeh viewing Dr. Rivadeneira’s bedside manner. friendly manner fit my style perfectly. a patient’s CT scan

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CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

Breast Care Gynecologic Center Oncology

tony Brook’s Breast Care Program is the Breast surgeons are available for evaluations and he gynecologic cancers arise in the ovary, The Division of Gynecologic Oncology provides only comprehensive academic program of consultations. Radiation therapy consultation is uterus (endometrium), cervix, vulva and complete care for women with gynecologic malig- Sits kind on Long Island. The program also offered. And, while lumpectomy is the pre- T vagina, as well as in the peritoneum and nancies. In 2004, there were 6,485 office visits and champions the multidisciplinary approach and ferred option for women with breast cancer, fallopian tubes. Together, these cancers account 1,313 new patients. Because the division is direct- continues to grow at a rapid pace, now caring for expertise in breast reconstruction is available for 13.3 percent of the new cancers afflicting ly involved with all aspects of patient care, a long- an estimated 300 to 400 new patients with breast when needed. Breast cancer support groups and women annually in the US. Although substantial term relationship may be established. This rela- cancer each year. Newly diagnosed patients are community outreach programs are coordinated strides have been achieved, the gynecologic can- tionship provides superb continuity of care and avoids many of the potential problems associated Program leaders are Brian presented and discussed at a weekly treatment through the center. cers still account for 10 percent of cancer deaths O’Hea, MD, director, Carol planning conference attended by cancer special- annually in women. with fragmented care. M. Baldwin Breast Care ists, offering critical multidisciplinary consultative Medical oncologists provide long-term care to Center; Alex Dagum, MD, input to this complex disease. patients with breast cancer after surgery. They The Division of Gynecologic Oncology is the only The physicians perform all surgical procedures chief, Division Plastic and Reconstructive Surgery; utilize novel chemotherapeutic regimens capable academic subspecialty gynecologic oncology necessary to treat gynecologic cancer or its Paul Fisher, MD, director, The Carol M. Baldwin Breast Care Center plays of dramatically improving survival. New combina- practice in Suffolk County. The division members complications, including radical pelvic and exen- Breast Imaging; Allen a pivotal role in providing key services. Breast tions of established drugs are being studied to have three overlapping goals: to provide compre- terative, gastrointestinal, urological and recon- Meek, MD, chair, structive plastic surgery. In 2004, the division Department of Radiation imaging specialists perform more than 8,000 establish the “standard regimens” of tomorrow. In hensive multidisciplinary care for women with Oncology; Balantry Aurora, mammograms and 2,000 sonograms each year. addition, oncologists provide a valuable resource known or suspected gynecologic cancers, as well performed 777 surgical procedures (506 major MD; John Brebbia, MD; The center, the first on Long Island to offer digital by making available phase II experimental agents as those with complicated gynecologic surgical and 271 minor procedures). Patients who require Martyn Burk, MD; Noshir mammography, has two digital mammography under study for patients with resistant tumors. and selected pre-invasive conditions; to conduct surgery are given a packet of educational mate- DaCosta, MD; Duc Bui, rial to assist them with preparing for surgery. MD; Louis Merriam, MD; machines and a specialized R-2 computerized research into the development and treatment of Roxanne Palermo, MD; mammogram double-checker. Breast imaging A highly specialized genetic counselor offers gynecologic cancers; and to educate healthcare A library of books and videotapes are available Colette Pameijer, MD; specialists are experienced in image-guided biop- consultation and support for women considering professionals and the public about gynecologic for patients and their families to review. Lynette LeePack-May, NP, sy procedures, including stereotactic mammo- genetic testing for inheritable breast cancer. A cancers and pre-cancerous conditions. nursing administrator; Catherine M.Tuppo, PT, tome biopsies and ultrasound-guided core biop- comprehensive, highly specialized lymphedema Lymphedema Program sies. The center is the only one in Suffolk County, evaluation and treatment program is offered and Marcy Demsky, and one of the few in the metropolitan region that through the Department of Physical Therapy. Genetic Counseling. offers MRI-guided biopies. In addition to clinical research projects, critical Stony Brook’s breast cancer surgeons were the basic science research is carried out at Stony first on Long Island to offer sentinel-node biopsy Brook University Hospital and at Cold Spring as a less invasive alternative to the standard Harbor and Brookhaven National Laboratories axillary-node dissection for patients with breast to gain a deeper understanding of the biology of cancer. Since then the sentinel-node program has breast cancer and to develop novel breast cancer Linda Mahler,NP, grown dramatically. Breast surgeons can now treatments. This cutting-edge basic science shares good news implant the new mammosite intracavity balloon research and its direct link to clinical cancer care with her patient device for accelerated partial breast irradiation. gives Stony Brook University Hospital breast This technique is used instead of traditional post- cancer specialists access to the most advanced lumpectomy radiation in selected patients. breast cancer treatment available anywhere.

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CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

Urologic Oncology

The division has extensive experience administer- end-of-life preferences, and several industry- tony Brook University Hospital’s urologic Current areas of research include evaluating the ing intravenous, oral and intraperitoneal chemo- sponsored phase II chemotherapy trials for surgery specialists are experienced in role of matrix metalloproteinases in prostate can- therapy. In 2004, the division administered 1,055 patients with either ovarian or cervical cancer. Streating malignancies of the urinary sys- cer metastasis, determining the process that leads chemotherapy cycles. The chemotherapy team is tem. The common ones include prostate cancer, to the hormone resistance of prostate cancer multi-disciplinary and consists of the physicians, A number of collaborative projects with scientists bladder cancer, kidney (renal cancer), and testicu- cells, and exploring new treatments to prevent a clinical pharmacist, two nurse practitioners, and in several departments have been established. lar cancer. Less common cancers of the urinary bone metastasis from prostate cancer. Investiga- Program leaders are several chemotherapy-certified nurses. Active In conjunction with the Department of Pharma- tract include tumors of the renal pelvis and ureter, tors in the Department of Urology in collaboration Michael L. Pearl, MD, patient cases are presented at a weekly Treatment cology, the division is investigating the levels of penile cancer and urethral tumors. These tumors with investigators in the Department of Medicine director; Ann Buhl, MD; Planning Conference attended by the members tamoxifen-DNA adducts in endometrium. In col- Eva Chalas, MD; Kent Chan, affect both men and women; however, these recently published data showing that membrane MD; Dayna McCauley, of the chemotherapy team. The physicians work laboration with the Department of Pathology, the tumors are more common in men. type 1- matrix metalloproteinase plays an impor- PharmD; Margaret Fischer, closely with the Department of Radiation division is investigating the role of p73 in gyneco- tant role in prostate cancer invasion and metasta- NP; Linda Mahler, NP; Oncology to develop treatment plans, place logic malignancies. A number of projects are un- The Department of Urology provides compre- sis. This research has not only expanded the Aimee Minton, CRA; and Mohini Jose, LCSW. brachytherapy devices and administer intra- derway with members of the Division of Medical hensive care for all genitourinary tract cancers current knowledge base for prostate cancer Research collaborators peritoneal radioisotopes. Oncology. The division is collaborating with Wen- ranging from screening of patients who are at risk metastasis, but may eventually lead to the devel- are Ute Moll, MD; Wen-Tien Tien Chen, PhD, Department of Medicine, to to the treatment of advanced disease. The depart- opment of new treatments for patients with Chen, PhD; Robert Lucito, Importantly, the division provides comprehensive develop a method for isolating viable ovarian can- PhD; Shinya Shibutani, PhD ment also provides access to clinical trials for advanced disease. Investigators in the Depart- and Michael Wigler, PhD. support services, including pain and symptom cer cells from blood and ascites and to identify patients with malignant tumors. ment of Urology in collaboration with investiga- management, referrals for counseling and early carcinoma antigens in patients with ovarian tors in the Department of Surgery have recently overseeing hospice care. The support group cancer using DNA microassay techniques. Prostate cancer is the most common tumor diag- published research demonstrating the utility of meets monthly and is facilitated by a licensed nosed in American men. While many men develop urine telomerase activity as a screening tool for certified social worker. In conjunction with Cold Spring Harbor Labora- urinary symptoms as they age, prostate cancer is prostate cancer. These results were encouraging tory, efforts are being made to identify genes that commonly diagnosed in patients who have no uri- as all patients with a negative biopsy had a nega- The members of the division conduct clinical and may play a role in the development and outcome nary symptoms whatsoever. In addition, a family tive urine telomerase assay. Furthermore, the basic science research in gynecologic cancer. of ovarian cancer using microarray-based screen- history of prostate cancer is a risk factor for de- presence of prostate cancer was also predicted Dr. Pearl is the principal investigator for the ing technology. veloping prostate cancer. Prostate cancer can be with high sensitivity and sensitivity by a positive Gynecologic Oncology Group (GOG), a national diagnosed by a digital rectal examination; how- telomerase assay. Future studies are planned to research organization funded by the National Didactic and clinical education is provided for ever, this procedure is most effectively used in a determine the potential benefit of using the urine Institutes of Health to provide patients access to medical students, resident physicians, nurses and combination with the Prostate Specific Antigen telomerase assay as a first-line screening test for cutting-edge therapy. At any given time, approxi- physician assistant students in the hospital and (PSA) blood test. Many patients with prostate can- prostate cancer. mately 25 chemotherapy trials are available for ambulatory settings. By participating in local, cer have a normal prostate examination, but an women with a variety of gynecologic cancers. In regional, national and international grand rounds abnormal PSA. There are many treatment options Cancer of the urinary bladder occurs in men and 2004, 63 patients were enrolled on GOG protocols. and other lecture series, the members of the di- available to a man with prostate cancer including women. Bladder cancer is the fourth most com- vision provide continuing medical education for surgery via open or laparoscopic techniques, radi- mon malignancy diagnosed in men and the tenth Institutional research trials have been developed physicians in many specialties. ation therapy with external beam and radiation most common cancer diagnosed in women. and conducted to improve the outcome for seed implant, cryotherapy, hormone therapy and Smoking is a risk factor for developing bladder patients with gynecologic cancers. Ongoing trials For the community, information about preven- other investigational therapies. All of these op- cancer. Stony Brook physicians perform a full include evaluating the role of chemotherapy tion, diagnosis and management of gynecologic tions are available at Stony Brook. evaluation for patients who present with symp- following chemoradiation for women with locally- cancers is provided through support groups and toms, such as blood in the urine. For those advanced cervical cancer, assessing patients’ lecture series. In addition to this clinical expertise, the Depart- patients who are diagnosed with bladder cancer, ment of Urology is collaborating with various there are many treatments available including areas of basic science prostate cancer research. surgery and the placement of chemical agents

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into the bladder. Patients who require removal Since 1989, the Prostate Care Program at Stony of the urinary bladder may be candidates for Brook has actively promoted and fulfilled its stat- creation of a new bladder from the intestine. ed mission and commitment to conduct cancer Urologists at Stony Brook are able to perform the screenings in accordance with the guidelines set procedure on eligible patients. Currently, there forth by the American Cancer Society. Excluding is a joint collaborative research effort between skin cancer, cancer of the prostate is the most the Departments of Urology and Biomedical common malignancy and the second leading Engineering evaluating the use of Optical cause of cancer death among men in the United Program leaders are Wayne Coherence Tomography (OCT) for the diagnosis States. The American Cancer Society estimated Waltzer, MD, chair, Urologic Oncology and Renal of bladder cancer. This OCT may help diagnose that in 2002 there would be 220,900 new cases of Transplantation; Howard L. and stage bladder cancers at an earlier stage prostate cancer and 28,900 deaths attributed to Adler, MD, Urologic Oncology, when the cancer is not visible with standard cysto- this disease in the United States. With early detec- Gene Therapy and Clinical scopic techniques. The Department of Urology tion of prostate cancer, this annual death rate Trials, director of the Prostate Care Program; Frank Darras, has also been working with the Department of is decreasing and men are afforded treatment MD, Renal Transplantation; Preventive Medicine in an evaluation of layperson options, which are dedicated to promoting the reach is to provide services to the underserved tions. The director of the Prostate Care Program Zelik I. Frischer, MD, knowledge of the risks and association of smok- highest quality of life possible. population of Long Island. The Prostate Care visits various organizations, schools, corporations, Incontinence and Voiding ing with the occurrence of bladder cancer. Program works with Stony Brook University libraries and other civic organizations to discuss Dysfunction, Pelvic Floor Reconstruction, Urologic From January 1, 2004 to December 31, 2004 the Hospital’s Health Initiative for Underserved the importance of prostate cancer awareness and Oncology and Renal Renal, or kidney cancer, also occurs in men and Prostate Care Program at Stony Brook screened Communities to provide the most direct com- screening. Transplantation; Sardar Ali women. It is often diagnosed during the early 1,109 patients. Of this group, 150 patients (13.5 munication to the African American community. Khan, MD, Erectile Dysfunction and Pelvic stages of the disease through routine x-rays of the percent) were referred for the evaluation of an This is critical given the prevalence of prostate Currently, the Prostate Care Program team has Surgery; Shahar Madjar, MD, abdomen for other reasons. Occasionally, patients abnormality in their PSA level or digital rectal cancer in African American men, which is twice initiated an extensive review of their database to Incontinence and Female will have the symptom of blood in the urine. examination. Many more patients presented the rate of Caucasian men in the United States. determine how many patients have been diag- Urology; Jamil U. Rehman, Patients with localized cancer can be treated with for the evaluation of other conditions including nosed with prostate cancer, the treatment they MD, Laparoscopy and Endourology; David A. removal of the kidney. In some cases, a portion of benign prostate enlargement, overactive bladder, Education and support are vital in the care of pa- received, and their current disease status. The Schulsinger, MD, the affected kidney is removed and the normal and erectile dysfunction. Furthermore, the tients undergoing cancer therapy. Every patient results of this research will add to the growing Endourology, Stone Disease kidney remains. These procedures may be done Prostate Care Program has assisted the Depart- who has a positive prostate biopsy is informed of body of medical literature regarding the benefits and Laparoscopy; Yefim R. with laparoscopy in patients who are eligible. ment of Preventive Medicine with the PSA and this result by his physician. In addition, each man of prostate cancer screening. Sheynkin, MD, Infertility and Robert J.Wasnick, MD, Patients with advanced disease are eligible for digital rectal examination follow-up of patients is given a packet of patient educational materials to Pediatric Urology. treatment with immunotherapy, which uses cy- participating in the Selenium and Vitamin E help in his understanding of the disease, treatment The prostate cancer support group at Stony tokines and other agents to stimulate the immune Cancer Prevention Trial (SELECT). options and expected outcomes. The Prostate Brook began in 1994 and meets on a monthly system against the tumor. Care Program has a library of videotapes and basis. In 1996, another group began to meet, Comprehensive prostate health and awareness books, which are also available for patients and composed of women who play a significant role Cancer of the testicles occurs most commonly education is provided for the community directly their families. More recently, a resource manual in the life of someone who has prostate cancer. Dr.Waltzer and patient during a follow-up visit in men between 18 and 35 years of age. These tu- via a series of screenings and lectures scheduled listing websites about prostate cancer has been At that time, the groups became affiliated with mors usually present as a painless mass in the tes- in fire houses, churches, libraries, senior centers, developed. The mission of community education the American Cancer Society. The men’s group ticle and can be diagnosed by testicular self-exam- Suffolk County Police precincts and regional clin- is accomplished by Stony Brook’s participation in is called Man-to-Man support group and the ination. The vast majority of patients with testicu- ic sites in order to establish an active partnership community health fairs, school health and aware- women’s group is called Side-by-Side support lar cancer can be cured with treatment, which in- with the community and to meet their healthcare ness activities and several employee wellness group. The meetings involve educational presen- cludes surgery, radiation, and/or chemotherapy. needs. A major component of the community out- programs hosted by various Long Island corpora- tations and group discussions.

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CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

Otolaryngology Head and Neck Oncology

he comprehensive, multidisciplinary ap- structures that are important for communication, and to develop improved treatment modalities, replace the missing tissues at the surgical defect. proach to management of head and neck such as the voice box, is now possible in a large such as gene therapy and immunotherapy to In this way, both function and esthetics are re- Tcancer at Stony Brook University Hospital percentage of patients. improve overall survival rates. Ghassan Samara, stored for patients. Somewhat similar to the prin- continues to provide patients with state-of-the-art MD and Kepal Patel, MD are currently involved ciples of tissue transplants, this highly sophisticat- care, resulting in an increased number of patients. The current trend today is to treat early stage dis- in studying the behavior of tumor cells at a molec- ed surgical technique, known as microvascular- The multidisciplinary team, consisting of head ease with single modality—surgery, radiation or ular level. free tissue transfer, requires sewing of blood and neck surgeons as well as nurses, nurse prac- laser, depending on the site of the primary tumor. vessels and nerves to re-establish blood flow, Program leaders are titioners in the Division of Otolaryngology Head For example, Stage I and II laryngeal cancers are Another significant advance in the treatment of sensation and motor function at the site of the Maisie Shindo, MD, director; and Neck Oncology, radiation oncologists, med- effectively treated with endoscopic laser excision head and neck cancer is in reconstruction of sur- reconstruction. By reconstructing the defects Arnold Katz, MD, chair, Division of Otolaryngology; ical oncologists, pathologists, diagnostic neuro- with excellent local control rates. The advantage gical defects after cancer removal. A team of high- with tissues of similar composition (e.g., bone, Prajoy Kadkade, MD; radiologists, interventional neuroradiologists, of this is shorter length of stay and good function- ly specialized surgeons with training in plastic soft tissue), speech, swallowing and masticatory Kepal Patel, MD; Ghassan speech pathologists and dentists, works to ensure al outcome. Stage III and IV cancers of the larynx, and reconstructive surgery of the face is able to function, as well as facial esthetics can be re- Samara, MD and Frances that patients are provided with the best compre- oropharyx and hypopharynx are generally treat- reconstruct extensive head and neck defects by stored, thus significantly improving the patient’s Tanzella, NP. Dr. Shindo and hensive treatment. Programs are dedicated to the ed with chemotherapy and radiation therapy, with transferring tissue from other parts of the body to quality of life. Frances Tanzella, NP, comprehensive care of malignancies arising in surgery reserved for failure. Very high complete during a patient the head and neck region. The spectrum of response rates can be achieved when radiation examination malignancies treated includes cancers of the therapy is delivered concurrently with chemo- aerodigestive tract, which includes oral cavity, therapy; however, this method of concurrent pharynx, larynx, nasal cavity, nasopharynx and chemo-radiation treatment can result in very sinuses, the thyroid gland and the salivary glands. disabling side effects, such as severe mucositis which can result in permanent xerostomia and There are two major goals in treating patients dysphagia. Surgical resection is still the preferred with head and neck cancer—controlling the initial treatment modality for oral cavity cancer of disease and maintaining a good quality of life. all stages. Significant strides have been made in treatment modalities that have improved the quality of life While current treatment modalities have im- for patients with head and neck cancer. Head and proved locoregional control rates for head and neck cancer is a very debilitating and emotionally neck cancer, the overall long-term survival rate distressing disease, as it can result in speech and for squamous-cell cancers of the aerodigestive swallowing impairment as well as facial disfigure- tract still has not improved dramatically over the ment. Advances in radiation therapy techniques, last decade. Overall, approximately 50 percent of such as modifying the dosing schedule, sophis- these patients will ultimately develop recurrence ticated computerized planning of x-ray beam at the primary site, in lymph nodes or at a distant delivery and direct implantation of radiation seeds site, such as the lungs. known as brachytherapy, have improved overall initial control of the cancer in the head and neck Members of the Division of Otolaryngology Head region. The local and regional control rates can and Neck Oncology, in conjunction with medical be improved by combining radiation with chemo- oncologists and molecular biologists, are collabo- therapy, especially by using newer drugs and im- rating on translational research to shed further proved delivery techniques. Thus, preservation of light on the behavior of head and neck cancers

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CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

Neurosurgical Oncology Oncology Nursing

he Department of Neurological Surgery at tony Brook University Hospital has a In 2005, the hospital’s oncology staff implemented Stony Brook University Hospital provides mission to provide excellence in patient a change in the caregiving process that placed T tertiary management of benign and malig- Scare, education, research and community patients at the center of their own care. This initia- nant tumors of the brain and spine. Physicians service. Those providing oncology services at the tive is called Patient Centered Collaborative Care. offer extensive experience in treating tumors of hospital have an obligation to provide to patients While a challenging endeavor, it is a required one in order to shift the emphasis from clinician- Program leaders are the brain and spine, in addition to expertise in Program leaders are Lee cohesive seamless services that span across the Raphael Davis, MD, complex spine surgery and spinal tumors. The Anne Xippolitos, RN, PhD, cancer care continuum. Oncology nurses are an focused care to patient-focused care. The corner- director; Michael Egnor, department also offers expertise in pediatric chief nursing officer and integral part of a team of professionals who have stone of this change is to place patients in the MD, Pediatric Neurosurgery; Rose Cardin, RN, MSN, neurosurgery. a mandate to be the drivers of these services center of the healthcare team, by supporting, Robert Galler, MD; associate director of Frederick Gutman, MD nursing. through education, research, strong leadership educating and empowering them to become part- and Arthur Rosiello, MD. Treatment of brain and spine tumors crosses and advocacy for a unique patient population. ners in their own care. several disciplines with strong collaborations existing between the Department of Neurological Oncology nursing is a dynamic, evolving disci- For the oncology nursing staff the process of Surgery and the Divisions Hematology and pline based on the knowledge of human health Patient Centered Collaborative Care begins with a Oncology, Pediatric Oncology and the Depart- derived from research, theory and practice. At thorough understanding of the patient’s condition, ment of Radiation Oncology, as well as the Treatment protocols in development include the Stony Brook University Hospital, oncology nurses the goal of therapy, monitoring responses to thera- Departments of Pathology, Radiology, Anesthesia use of chemotherapy wafers during the initial have roles in all aspects of caring for patients with py, reassessing and documenting signs and symp- and Neurology. Medical experts convene on a craniotomy and resection of high-grade glioma as cancer in addition to opportunities to expand their toms, and communicating pertinent information regular basis as part of the multidisciplinary combination regional therapy with intra-carotid Margarree Perry, RN, scope of practice beyond the bedside. Oncology to other members of the healthcare team. The tumor board, where tumor cases are presented cisplatinum and etoposide. with a patient in the nurses work in adult and pediatric inpatient units, staff performs continual psychosocial evaluations and discussed to formulate treatment plans. Chemotherapy Infusion ambulatory care, radiation oncology, clinical and patient teaching throughout all phases of Stereotactic radiosurgery to treat benign as well Suite trials, chemotherapy and infusion units, consulta- care, something that requires astute caregivers In partnership with the Division of Hematology as malignant tumors is performed in collaboration tion and liaison services and in the hospital’s and astute nursing interventions. Oncology nurs- and Oncology and the Department of Radiation with the Department of Radiation Oncology. It recently expanded Blood and Marrow Stem-Cell es have the privilege of interacting closely with Oncology, new treatment protocols are being in- offers patients with recurrent tumors an addition- Transplant program. patients who demonstrate courage during the vestigated. Stony Brook is one of the few centers al therapeutic option. course of their treatment whether the disease is across the country and the only center in the New cured, in remission, under control or progressing. York metropolitan area that offers intra-carotid State-of-the-art techniques and equipment are Dr. Gutman views Plans of care are individualized to meet the needs an MRI of the brain cisplatinum and etoposide for the treatment of used during surgical treatment of brain and spine high-grade glioma of the brain. Delivering this tumors. The Department of Neurological Surgery of every patient and their families by incorporat- regional chemotherapy regimen prior to radiation uses image-guided neuronavigation that allows ing preventive, therapeutic, rehabilitative and therapy has doubled the median survival of pa- the aggressive resection of brain tumors previous- palliative nursing interventions. Oncology nurses tients with glioblastoma compared to convention- ly deemed inoperable. The department also uses at Stony Brook exhibit integrity and earn patients’ al radiation and intravenous BCNU (carmustine). intra-operative ultrasound, awake craniotomy and trust through uncompromising professionalism. The Department of Neurological Surgery also cortical mapping for surgery near sensitive areas They demonstrate expert clinical knowledge to offers regional chemotherapy for recurrent of the brain, operating microscopes for micro- ensure that patients and their families receive glioma in the form of carmustine-impregnated surgery, evoked potential monitoring for spinal safe, quality care. Oncology nurses are account- wafers implanted during craniotomy for the tumors, and ultrasonic surgical aspirators for the able for promoting and upholding standards of resection of recurrent tumors. removal of brain and spine tumors. care and practice. They are required to evaluate the effectiveness of treatments and to evaluate how their care promotes quality and safety with measurable outcomes.

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CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

Diagnostic Radiology

iagnostic imaging plays a central and criti- into increased accuracy and speed, along with the research on making the preparation for virtual Physicians from the Radiology Department cal role in initial cancer diagnosis, treat- ability to produce high-resolution 3-D images. colonoscopy more tolerable. Many of the physi- provide consultation at the multidisciplinary Dment planning, palliative therapies cists in the department are involved in improving tumor board meetings and review images at through interventional techniques and cancer Two magnetic resonance imaging (MRI) scan- MRI and other CT protocols and developing new case presentations. monitoring. The Department of Radiology at Stony ners have been replaced with state-of-the-art 1.5 modalities for breast cancer imaging. Brook University Hospital offers state-of-the-art Tesla (high-field) machines. A 3-Tesla MRI has clinical care as well as support of major research been installed, which is currently the highest projects in a number of modalities in both basic strength magnet in Suffolk County. These new science and clinical areas. The department has MRI scanners will increase speed and accuracy Program leaders are of diagnosis and offer improvements in spectro- Donald P.Harrington, MD, been undergoing expansion and enhancement of director; Paul Fisher, MD; services with the addition of healthcare experts scopy, allowing for non-invasive diagnosis of Seth Mankes, MD; William and the acquisition of leading-edge equipment. malignancies. The ultrasound units have been up- Moore, MD; Roxanne graded with tissue harmonics and increased field Palermo, MD; Steven Perlmutter, MD and During the past year, the department welcomed of view, and some now have the ability to perform Sol Spector,MD. additional faculty members who not only augment 3-D imaging. The department recently installed existing capabilities but who also bring expertise and continues to upgrade a Picture Archiving and in a variety of new areas such as thoracic disease, Communications System that allows rapid access breast imaging and computed tomography (CT) to viewing computerized (digital) images at of the abdomen and pelvis. multiple sites for both radiologists and clinicians.

The department has been expanding, purchasing Several of the radiology faculty are involved with new equipment and upgrading existing machin- research projects related to cancer imaging. ery. A positron emission tomography computed Edward Fiore, MD, is among an international tomography (PET CT) scanner—a radically new group of researchers collecting data at multiple technique that combines the strengths of nuclear institutions to assess the accuracy and utility of Dr. Harrington at the medicine, which can detect abnormal function, low-dose CT screening for early detection of lung new 3-Tesla MRI unit with CT, which has exquisite ability in detecting carcinoma. One of the newest faculty members, morphologic changes, has been installed. This William Moore, MD, is participating in a study machine has substantially increased accuracy in with the Pulmonary Medicine Department in lung detecting and staging malignancies. Approval for cancer staging. The Nuclear Medicine section, a major upgrade that will allow diagnostic CT spearheaded by Cora Cabahug, MD, and Dinko studies with oral and intravenous contrast to be Franceschi, MD, are part of a joint project with performed in conjunction with PET, alleviating the Pulmonary Medicine Group at Stony Brook the need to undergo additional, separate CT University investigating the accuracy of PET in exams is anticipated shortly. differentiating benign from malignant lung nod- ules. Erica Posniak, MD, and Jerome Liang, PhD, Three new CT scanners are now on line replacing are part of an ongoing initiative to determine the single-slice helical CT capability with multi-slice accuracy of virtual colonoscopy, a technique capability. The most advanced of the scanners where CT images are used to create simulated can simultaneously obtain 16 slices as small as colonoscopic images in screening for premalig- 0.625 millimeters in 0.5 seconds. This translates nant colon lesions. Dr. Liang is also performing

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Community Pathology Outreach

athology Department faculty members are an integral part of the multidisciplinary Cancer Liaison Education and Support cancer care team at Stony Brook P Physician Community outreach plays a significant role in the Cancer Care Program. The University Hospital. Recent advancements Department of Patient Education offers seminars and lectures, health screenings supporting the cancer care program include the The physician liaison works with the Cancer and programs dealing with wellness and prevention. A key focus is smoking cessa- use of synoptic protocols for reporting cancer Committee, helping it to meet cancer program tion for patients and community members. A six-week series is offered providing specimens. The department further supports goals such as expanding community outreach in behavior modification to treat nicotine addiction. Cessation and education programs the cancer care program by its involvement in cancer education and prevention in underserved are also offered in partnership with the Suffolk County Department of Health and Program leaders are Jay expanded departmental and site-specific cancer communities, and interfacing with community the Tobacco Action Coalition of Long Island. The American Cancer Society has L. Bock, MD, chair, Pathology conferences supported by Department of Path- Department; Carmen Tornos, resources for cancer control activities. awarded the hospital two grants for smoking cessation, ology faculty with relevant specific interest in MD, director,Anatomical one for patients and the other for employees. In part- Pathology; Alan Heimann, the various specialties, which include breast, gy- In providing direction and support for the hospi- nership with the Ward Melville Heritage Organization, MD, director, Cytopathology; necology, colorectal and lung cancer, melanoma, tal’s cancer program according to criteria set by a cancer education series covers four cancer topics Youjun Hu, MD, director, leukemia and lymphoma. altered functions of the tumor suppressor protein Frozen Tissue Bank; Philip the Approvals Program of the Commission on throughout the year and is held at the Ward Melville p53; and carcinogenic effects of ionizing radiation. Kane, MD; Bernard Lane, Cancer, the liaison works with local community Community Center. The Carol M. Baldwin Breast Care MD; Sharon Liang, MD; Clinical pathology has introduced several new agencies and the American Cancer Society to Center holds a monthly breast education program with Jingxuan Liu, MD and tests related to cancer, including expanded A Frozen Tissue Bank established within the Frederick Miller, MD. develop and support cancer control programs a wide range of speakers. The Social Work Department is completing its second six- cytogenetic services and molecular tests using Department that allows storage and analysis of for the community and uses data to evaluate pro- month education program on cancer support issues. The hospital participates in real-time polymerase chain reaction. Anatomic human tumors for correlations of molecular grams. Stony Brook University Hospital’s cancer National Hospital Week activities to promote health and wellness for employees and Pathology is performing testing for epidermal tumor characteristics with serum biomarkers and liaison physician, Jedan Phillips, MD, is working community members. Community education is also provided through the hospital’s growth factor in relation to colon cancer. The clinical outcomes is being utilized by our oncolo- with the Department of Family Medicine on a ret- Better Health, Better Living, a widely distributed quarterly publication for the com- Anatomic Pathology information systems up- gist specializing in medicine and surgery. The rospective review project utilizing Medical Society munity that contains information about seminars, workshops, screenings, clinical grades allow for standardization in the diagnosis Frozen Tissue Bank has a laser dissection micro- and US Preventive Task Force Guidelines to de- trials and healthcare issues. Information for both professionals and community and treatment of cancer. scope to aid in sophisticated studies on tumors. termine the hospital’s effectiveness in informing members can be obtained at www.stonybrookhospital.com, which links to Stony patients about cancer screening. Dr. Phillips con- Brook’s Long Island Cancer Center and Health Resource Center. Clinical and research advancements in pathology tinues to meet with volunteers for the Witness continue to support the cancer program. Cancer Project® of Long Island and works with lay per- Stony Brook staff also work with the community to raise consciousness about continues to be a primary focus of basic research sons and cancer survivors to educate the African cancer and to raise funds to support cancer care and research. On National Cancer in the Department of Pathology, with programs American community about the risks of breast Survivors’ Day, Stony Brook hosted its first “Carousel of Life,” a celebration of life addressing molecular events associated with cancer and the importance of routine screening and hope. The “Rising Stars” Talent Show provides children with cancer an opportu- tumor-cell invasiveness; mechanisms responsible exams. As cancer liaison, he has also reached out nity to express themselves through theater arts. This year marked the hospital’s for immortalization and dysregulation of the cell to the community in two programs—Let’s Talk ten-year anniversary of “Look Good…Feel Better,” an American Cancer Society cycle in tumor cells, particularly with regard to About It, a program for men of color concerning community-based program to support women undergoing cancer treatment. Annual Dr.Tornos examines a the risks of prostate cancer, and the Town of events to raise funds include Walk for Beauty, Fall Fashion Festival, Little Miracles tissue specimen Babylon Women’s Day Program concerning is- Fashion Show and Run for Life, among others. Funds have been raised by the hospi- sues related to breast cancer. Dr. Phillips was tal/School of Medicine’s Gala, and events hosted by the Carol M. Baldwin Breast awarded with the American Cancer Society’s 2005 Cancer Research Fund. Many activities are held by community organizations and Life of Hope award for cancer education in under- hospital divisions during the year in support of the hospital’s cancer care programs. served communities. Program leaders are Sabra Boughton, NP,PhD; Lynette LeePack-May, NP; JoAnn McCaslin, The cancer liaison physician is Jedan Phillips, MD, LCSW and Vimala Sivaraman, MD. Family Medicine.

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CANCER CARE AT STONY BROOK UNIVERSITY HOSPITAL ANNUAL REPORT 2005

MICHAEL TREANOR:STANDING GETTING STRONG THE FORBEST TREATMENT AMERICA’S FIRST RESPONDERS

Some were on site in site on Long Island. “Those who offered nary amount of dust, debris and gases. It help—the ‘first responders’—are hard- is not known what the impact will be on a matter of minutes working, heroic people, who are the best the long-term health of these individuals.” following the initial of any community,” says Benjamin Luft, The monitoring program allows a team MD, professor, chair of Stony Brook of physicians, a psychiatrist, industrial hy- impact. Others were University Hospital’s Department of gienists, pulmonologists, social workers, there as the second Medicine and director of Stony Brook and others to obtain a detailed evaluation University’s Long Island Occupational and of the exposure after patients undergo a plane hit the south Environmental Health Center (LIOEHC). comprehensive examination. Linda tower. Still others “They came to our aid and they cannot be Cocchiarella, MD, M.Sc., acting director overlooked.” More than $7 million in of the Long Island Occupational and arrived as the un- grant money is enabling Stony Brook Environmental Health Clinic, explains: thinkable happened University Hospital to expand clinical and “We want to evaluate people whether or other services for 1,800 Long Islanders not they are currently exhibiting symp- when the towers involved in the emergency effort, and will toms. In the course of three examinations collapsed in a cloud help to ensure that these men and women performed at 18-month intervals, it is are neither forgotten nor overlooked. The highly likely that we will be able to identi- of debris and vapor. LIOEHC is the only institution on Long fy developing health issues or determine Island to receive federal funds for the whether an existing condition has been In the hours and days that followed, they World Trade Center Medical Monitoring exacerbated as a result of the exposure.” came dressed in uniforms or in work gear, Program, which was established with a Physicians are finding respiratory infec- armed with the tools of their trade. These five-year $5.2 million grant from the tions, chronic cough, nasal congestion, men and women, known as “first respon- National Institute of Occupational Safety asthma, acid reflux, sleeping disorders, ders,” entered into an area of unknown and Health (NIOSH). Additional grants depression, anxiety and post-traumatic with a singular purpose—to rescue vic- from the American Red Cross September stress disorder. Their goal is to intercede tims and save lives. Some lost their own 11 Recovery Program Liberty Disaster and mitigate these problems. “Most of the lives in the process, and for those who Relief Fund totaling more than $2 million people I treat carry with them a sense of survived, the mission too quickly changed will help support the study of physical and loss that they feel each and every day. In to one of recovery and clean up. mental health ailments, ongoing and new, spite of that, they remain, for the most

Melodie Guerrera, Dr. Luft, Dr. Cocchiarella and 9/11 Responder John Sferazo

More than 25 percent of the first respon- of first responders and their families. The part, hopeful. Some are symptom-free and ders to the World Trade Center attacks LIOEHC works jointly with the Nassau are being proactive in monitoring their were from Long Island and more than 25 County University Medical Center to health; others are suffering from serious percent of those first responders who lost operate a second site in Nassau County. medical and mental health conditions and their lives were also Long Islanders. That may face lifelong illnesses. Funding now, is why many fought long and hard to se- As Dr. Luft, principal investigator of the and hopefully well into the future, will cure funding to support initiatives to pro- grants, notes, “Those who responded to help to provide the appropriate care for vide healthcare assistance for them at a the disaster were exposed to an extraordi- this population,” adds Dr. Cocchiarella.

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CANCER CARE AT STONY BROOK UNIVERSITY HOSPITAL ANNUAL REPORT 2005

AMERICA’S FIRST RESPONDERS Clinical

Prior to September 11, 2001, John Sferazo, air that he knew was caused by the re- anticipated total participation of 1,800 over Support prided himself on hardly ever having lease of noxious materials, a result of the the next four years. Although most partic- missed a day’s work. A structural iron- meltdown of all the computer equipment. ipants are from Nassau and Suffolk coun- worker with Local 361, the married father ties, eligibility is determined by activity of three was a healthy, trim and athletic- Not long after the weeks spent at and near at the Trade Center site or surrounding Chemotherapy Nutritional Services looking 46-year-old who wasn’t afraid of Ground Zero, John began developing areas; residence is not a factor. Pharmacy hard work. In addition to holding licenses respiratory infections, for the first time in Recent innovations in cancer care recognize the relationship between diet, in welding and burning, which he taught his life. As the weather grew colder, he Dr. Luft, too, is determined that the med- nutritional status and cancer in both adult and pediatric patients. Stony Brook At Stony Brook University Hospital patient safety in apprenticeship programs, he earned a got sicker and sicker, eventually contract- ical community maintains its resolve to registered dietitians specialize in the care of oncology patients and are commit- is a priority. To provide comprehensive and safe DEC certification in Wilderness Search ing pneumonia. With assistance from his help those who worked selflessly under ted to the philosophy of early intervention for nutritional problems. It is impor- chemotherapy services, the hospital utilizes and Rescue. In the early morning of union he began seeing a pulmonologist the most dire conditions. “We are working tant for individuals to consume a nutritionally adequate diet during cancer specially trained and credentialed chemotherapy September 11, 2001, John was working and by the beginning of 2002, John, con- closely with the unions whose members treatment. Poor nutritional status may cause intolerance to the treatment plan, pharmacists to review, prepare and dispense all on a project on the Marine Park Bridge in tinuing to work, filed for workers’ com- were affected, community-based organiza- necessitating breaks in therapy, dose reductions, or extended hospitalizations. chemotherapy. Multiple double-check processes Brooklyn. He recalls the collapses: “From pensation benefits. John is now enrolled tions and volunteer organizations to reach Patients will feel better and be able to tolerate their course of treatment when are in place to ensure patient safety. A computer our vantage point, you couldn’t see clearly in the WTC Medical Monitoring Program as many people as possible who respond- they consume adequate nutrition. Unfortunately, eating well is not always easily database is maintained by the pharmacists that what was happening because of the dust offered through the LIOEHC, where pa- ed on September 11,” says Dr. Luft. “Only accomplished for patients with cancer. Registered dietitians are available to help highlights the specifics of all chemotherapy drugs and debris.” His face contorts slightly tients are seen at offices in Islandia, after through ongoing vigilance in the Medical patients experiencing problems with eating that may be caused by side effects and doses administered. This computer database when he adds, “But you could hear what he initially enrolled in a similar program Monitoring Program will we fully recog- of radiation therapy, chemotherapy, or surgical procedures, or from the cancer also aids in the identification of potential adverse was happening. You could hear the at Mt. Sinai Hospital in Manhattan. nize the ramifications of the World Trade itself. The dietitian will provide the patient and/or the caregiver with individual- drug reactions before they can occur. screeching and squealing of the metal Through the program, his health will be Center disaster on those who responded.” ized, practical written information and verbal counseling to minimize any side as each tower collapsed.” He and his monitored and he will receive the appro- effects the cancer treatment may have on the patient’s ability to eat well. Over the past year, 10,590 doses of chemotherapy coworkers quickly mobilized to make priate referrals, testing and treatment. Besides providing care for the immediate were prepared and dispensed to outpatients and arrangements to get to the site with the Disabled, John can no longer work. He and projected physical and mental well A registered dietitian assesses each patient. Inpatient nutritional services focus 2,647 doses were prepared and dispensed to equipment to help. They arrived on the has become an outspoken advocate to being of the first responders, physicians on patients receiving optimal nutritional intake during their hospital stay. inpatients. These statistics represent an overall scene very early the next morning with ensure that 9/11 responders receive the and researchers are hoping to learn much Special attention is given to patients to ensure that foods they will enjoy are increase of nine percent over the previous twelve police and fire department trucks escort- services and financial support they need. from their common experience. “This is a made available by discussing with them their food preferences and offering months. ing them. John remembers going first into unique situation. It was by far the largest menu alternatives, when possible. To assist in that effort, an executive chef his “search and rescue” mode, knowing Melodie Guerrera, director of adminis- group of people exposed to industrial oversees all food preparation. Nutrition education is provided to help the patient Program leaders are Jeannene Strianse, RPh, MS, that his services as a burner would also tration and outreach for the Long Island toxins, dust and debris that we know of— director; Benny Chan, RPh and Scot Weber, RPh, BCOP. continue to maintain adequate intake upon discharge. be needed. Working with a police officer Occupational and Environmental Health and, we know the timeframe of the expo- and a rescue dog, John took turns crawl- Center, coordinates the many aspects of sure, an important factor in research,” Outpatient nutritional services focus on developing and maintaining an eating ing in and out of the openings to the cav- the programs offered under the grants. A says Dr. Luft. Information about what has strategy to minimize treatment side effects that may hinder intake. Outpatients erns that had been created by the fallen key part of her mission is to get the word already happened to first responders, and are monitored continually and plans are modified as necessary. Registered dieti- debris, looking for any signs of life. “Even out to those who would benefit greatly by what may eventually happen, will help tians provide follow-up care and nutrition education to the community through after three, four, five days, we expected to participating. “This assistance is here to researchers understand how exposure to nutritional counseling, community support groups and educational programs. find survivors. That’s what kept you help the responders regain their lives,” different toxins can lead to chronic dis- going,” says John. He continued search- she says. “We want to reach out to every- ease, including cancer. Says Dr. Luft, “The In the past year outpatient nutritional services has consulted over 250 new ing at the site and burning twisted metal one who helped…the electricians, transit best scenario would be that the majority of patients. The outpatient nutritional staff is available Monday through Friday and for approximately 30 days, some nights workers, sanitation workers, communica- these brave men and women do not expe- may be contacted through HealthConnect® at 631.444.4000 or by scheduling an returning home to his family on Long tions people, everyone, including those rience serious problems. But, in the event appointment at 631.444.1880. Island. At times, while working, he who worked beyond Ground Zero, in they do, we need to be there for them.” coughed up what he describes as “silver places such as the landfill, morgue and Program leaders are Kathleen Werther, director; Janice Antino, RD, inpatient pediatric dollars.” He also describes seeing some- surrounding areas.” To date, screening, For more information about services oncology dietitian; Jennifer Fitzgibbon, RD, inpatient adult oncology dietitian and thing he had never seen before, an eerie medical and social support services have for September 11th Responders, call Gretchen Garlow, RD, outpatient oncology dietitians. green-colored smoke floating through the been provided to over 1,200 people, with 631.642.9100.

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CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

Pain Management Physical Rehabilitation and Chaplaincy Services Social Work Services Lymphedema Therapy The Department of Anesthesiology’s Acute and Chaplains of the various spiritual and religious Social Work Services are an important component of the services available to Chronic Pain Management Services is staffed by traditions visit patients with cancer throughout the oncology patients and their families. Social workers are assigned throughout The Department of Physical and Occupational Therapy provides both inpatient anesthesiologists with a special expertise in pain hospital. They provide counsel for the spiritual care the hospital to address the concerns and needs of patients and their families. and outpatient physical rehabilitation services for adult and pediatric oncology management. Through a multidisciplinary ap- of patients and families, and work with the hospice A psychosocial assessment is made of each patient to determine what, if any, patients. These services may include exercise for improvement of movement, proach, the expert team of anesthesiologists program to offer spiritual support. They attend services he or she require. strength and endurance; ambulation training; activities of daily living; and lym- works with the patient’s oncologist to address multidisciplinary rounds and are active in cancer phedema management. All patients referred for either physical or occupational pain management needs. Patients can be treated support groups and bereavement support. Social workers address the needs of patients throughout the continuum of care. therapy receive a detailed assessment. An individualized treatment plan is de- with many different modalities, on an inpatient as They address the psychosocial, emotional and family needs as well as entitle- veloped incorporating the goals of the patient and family. Close communication well as an outpatient basis. Hospitalized patients Program leaders are Chaplain Stephen Unger, director ment to programs and other concrete services. The Department of Social Work is maintained with the referring physician throughout the course of treatment. and Chaplain Anne Coulehan. can receive oral, intravenous (IV), or central axis Services is responsible for providing support groups to assist patients and their (epidural or intrathecal) medications given families. The Lymphedema Therapy Program targets the specific needs of patients with either through conventional routes or via patient- secondary lymphedema resulting from the effects of cancer treatment. This out- Palliative Care controlled analgesia (PCA). Program leaders are Charles L. Robbins, DSW, director; Mohini Jose, LCSW, supervisor patient program has grown since its development in 1998. Three physical thera- and GYN/Oncology; JoAnn McCaslin, LCSW, supervisor; Shirley Calhoun, LCSW, Carol M. pists have been specially trained and are dedicated to lymphedema treatment. The hospital has moved forward to initiate palliative Baldwin Breast Care Center; Paulet Farquharson, LCSW, Surgical Oncology and Radiation Outpatients are seen offsite at the Center for Pain Oncology; Erin Hendrickson, LMSW, Medical Oncology; Darlene Ernest Kenny, LCSW, Eighty percent of these patients have breast cancer-related lymphedema, while care services to provide end-of-life symptom man- Management located at 181 Belle Mead Road, Medical Oncology and Blood and Marrow Stem-Cell Transplant Program; Kevin Lycke, ten percent of the patients have lymphedema related to other cancer diagnoses. agement for patients with advanced disease. Devel- LCSW,Pediatric Oncology and Geoffrey O’Connell, LCSW,Prostate Cancer Support Group. Suite 5, in East Setauket, a short distance from The Lymphedema Therapy Program follows the principles of complete decon- opment of the program includes obtaining adminis- Stony Brook University Hospital. At the center, gestive physiotherapy (CDT) using manual lymph drainage, compression band- trative support, introducing the language and phi- patients can be treated with one or more modali- aging and compression garments, skin care, exercise and patient education. losophy of palliative care, devising an educational Cancer Helpline ties, such as medication management, regional plan, and reviewing a variety of clinical assess- blockade, or acupuncture treatments. When In addition to patient care initiatives, the department is actively involved in com- ment tools. Continuous Quality Improvement and Early detection of cancer yields the greatest chances for a cure. The Stony appropriate, patients may also undergo interven- munity education participating in support groups for breast and gynecological Nursing Administration have conducted multidisci- Brook University Hospital Cancer Helpline encourages callers to act promptly tional pain blocks, or surgical pain management cancers and in educational programs for patients, families and healthcare plinary meetings to assess and identify palliative in order to increase their opportunities for early detection. A call to 800.862.2215 techniques, such as spinal cord stimulation or professionals. Research interests in- care needs. A palliative project model has been connects patients and their family members to Stony Brook oncology nurses, intrathecal pump placement. clude factors that may assist in the early developed that includes a consultative support who are available Monday through Friday from 8:30 am to 7 pm. The commu- detection of lymphedema and the poten- service incorporating the language of palliation into nity can also access the Cancer Helpline website to send an email or post a fre- The pain service is available for both inpatient and tial influence of breast reconstruction faculty and staff education. Key staff participated quently asked question via the hospital’s website. The oncology nurses staffing outpatient consultations. The physician on call for on patients with lymphedema. in the Dissemination of End-of-Life Education to the Cancer Helpline are sensitive healthcare professionals attuned to the pa- acute pain consultation can be contacted through Cancer Centers practice model at the City of Hope tient’s specific needs and concerns. All calls are kept confidential and questions the hospital’s Anesthesia Pain Service. The program leader is Catherine M.Tuppo, Palliative Care Project in Duarte, California. Future are addressed based on the most current cancer information available. Nurses MS, PT, CLT-LANA, director, Physical and plans include recruitment of a team that includes have access to a computer information network that is supported by a database Occupational Therapy and director, Program leaders are Peter S.A. Glass, MB, ChB, FFA a physician, social worker, nurse practitioner and with the latest information from the National Cancer Institute, the American (S.A.), chair,Anesthesiology; Carole W.Agin, MD, Lymphedema Therapy. director, Center for Pain Management (chronic); nutritionist to implement a train-the-trainer model Cancer Society, Stony Brook University Hospital and approved reference texts. Paul H.Willoughby, MD, director, anesthesia,Acute to educate clinical staff and communicate with Questions on prevention, risks, screening, detection, second opinions, terminol- Pain Management; Rosaline Jerome, MD; Irina clinical faculty at joint practice meetings. Vision and ogy and current research are addressed. The nurses can match a caller with Lokshina, MD; Farrokh Maneksha, MD and Julie management standards are in place to promote physicians or community services, if requested. Scheuermann, NP. awareness of the palliative care model. Program leaders are Teresa Beutel, MS, director, Healthcare Teleservices/Resource Centers and Lori Tischler, RN, MSN, oncology nurse. The program leader is Antoinette Forster, NP. 30 31

CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

The Barbados National Cancer Study is a PhD. Blood drawing is done in the GCRC verted into several metabolites, one of collaborative effort among Stony Brook, under the direction of Marie Gelato, MD, which is activated further by a group of the Ministry of Health in Barbados, the PhD, GCRC program director. enzymes and reacts with DNA, especially Research University of West Indies and the National in endometrial tissue, to form a complex Institutes of Health (NIH), and is funded Galina I. Botchkina, PhD, Surgery/ structure called a DNA adduct. These by the National Human Genome Research Surgical Oncology, is conducting a study tamoxifen-DNA adducts code wrong nu- Institute. on early, noninvasive/minimally invasive cleotides during DNA replication, which asic and clinical research attempt vitamin D supplementation trial will be Preventive Medicine, Surgical Oncology, molecular cancer detection based on levels generates mutations that initiate the devel- to uncover possible causes of can- released in February 2006; WHI follow-up and Gastrointestinal Divisions in the The Long Island Cancer Center Database of telomerase activity to determine molecu- opment of cancer. Bcer; develop improved methods for has been extended through 2010. Almost Departments of Medicine, Pathology and Project on breast and prostate cancer, lar markers for gastrointestinal cancers prevention, early diagnosis and treatment; 3,400 women have enrolled in the Stony Diagnostic Radiology. The University will supported by a $1 million Department of and prostate cancer, and then developing Dafna Bar-Sagi, PhD, chair, Department and discover cures. The Department of Brook WHI Clinical Center. Dr. Lane is work in conjunction with the Suffolk Health and Human Services grant received large-scale clinical trials based on these of Molecular Genetics and Microbiology, Preventive Medicine is the research affili- also PI for two new National Cancer County Department of Health Services, in 2002, provides a resource of information markers. She is collaborating with Martin continues to investigate a genetic defect ate of the Long Island Cancer Center Institute (NCI)-supported research proj- along with the support of the American and biologic material for genetic and pro- Karpeh, MD, chief of Surgical Oncology, in mice that leads to pancreatitis, which (LICC). The residency program in General ects, titled “Reducing Barriers to Breast Cancer Society and community groups to teomic studies on these cancers. Blood and Howard L. Adler, MD, director, subsequently may also lead to pancreatic Preventive Medicine and Public Health, Cancer Screening” and “Colorectal Cancer provide colonoscopy, follow-up care, and samples and medical histories from pa- Prostate Care Program. Basic research ductal adenocardinoma (PDA) supported now in its 21st year, received training sup- Screening in County Health Centers.” conduct public education and outreach on tients and control participants are collect- is funded by the Department of Defense by a $100,000 grant from the Lustgarten port from the American Cancer Society Catherine Messina, PhD, is co-PI; colorectal cancer screening. Screening ed to study cancer predispositions and and the NIH; funds are being sought for Foundation for Pancreatic Cancer Re- and a federal Health Resources and John Chen, PhD, is a co-PI; and Mary colonoscopies will be done by Stony Brook search for detection of molecular markers clinical trials. Dr. Botchkina is collaborat- search. The mutation activates trypsino- Services Administration Grant that con- Cavanagh, MD, MPH is the co-investigator gastroenterologists and other gastroen- for potential early diagnosis. As of Sept- ing with the University’s Department of gen, a protein secreted by the pancreas tributed to teaching, cancer research and and project coordinator. terologists in Suffolk County. The effec- ember 2005, 874 individuals have entered Electrical and Computer Engineering and is the same defect found in some community service on Long Island. Pre- tiveness of the program will be evaluated the database including 323 women who and Advanced BioPhotonics Inc. on the people with hereditary pancreatitis (HP). ventive Medicine conducts a number of The hospital and the School of Medicine during the three-year grant period. Co-in- have had breast cancer and 278 who have development of the Telomerase and Gene Those with the mutation and HP have a 40 cancer research projects and provides core will receive $2.1 million over the next three vestigators with Dr. Lane are Joseph not had breast cancer, and 74 men who Analyzer based on the real-time PCR/capil- percent or more lifetime risk of developing support primarily in biostatistics and epi- years from the Centers for Disease Control Anderson, MD, lead endoscopist, Mary have had prostate cancer and 168 who lary electrophoresis for clinical instrumen- PDA. Dr. Bar-Sagi and colleagues plan to demiology for research by other depart- and Prevention (CDC) to launch a colo- Cavanagh, MD, MPH, lead public health have not. More than 450 participants tation needs. unravel the mechanism that activates the ments throughout the hospital and univer- rectal cancer screening demonstration clinician and Catherine Messina, PhD, completed a one-year follow-up and 70 digestive enzyme trypsin (converted from sity. As a premier academic medical center, program for low-income adults age 50 and project data manager. participants completed the two-year follow- Tamoxifen remains a first-line form of trypsinogen) and induces pancreatitis in Stony Brook has researchers who are older who have little or no health insur- up. The project is expected to end January hormone therapy for breast cancer and a the mice and subsequently develop innova- actively engaged in promising scientific ance coverage for regular screenings. Dr. As one of the centers throughout the US, 1, 2006, with a total participation of 500 chemopreventive agent for healthy women tive methods for early diagnosis of pancre- studies. Research includes participation in Lane is director of the new program, titled, Canada and Puerto Rico participating in women who have had breast cancer and at risk for developing the disease. Women atitis and predisposing conditions of PDA, prominent national studies, community- Suffolk County Preventive Endoscopy the Selenium and Vitamin E Cancer Pre- 400 who have not. Accrual of patients with who take it are at a small but increased risk as well as create therapeutic interventions. based projects and scientific investigation (SCOPE). Stony Brook is one of five insti- vention Trial (SELECT) sponsored by the prostate cancer and participants in the of developing endometrial cancer as an Researchers hope to discover how to inter- and laboratory research. tutions nationwide to receive CDC funding NCI, Stony Brook completed its enroll- control group will continue after January 1, adverse effect. Shinya Shibutani, PhD, fere with the consequences of the mutant for this program, which provides free ment with 372 men, among the highest in 2006. This segment of the project “piggy- Pharmacological Sciences, is studying the trypsin activation in mice to learn more Dorothy S. Lane, MD, MPH, is principal colonoscopies for qualifying individuals; it the nation. This 12-year prevention clinical backs” on the Selenium and Vitamin E mechanisms behind tamoxifen-induced about the role of chronic inflammation in investigator (PI) and Iris Granek, MD, MS, is the only academic medical center select- trial is designed to study whether selenium Cancer Prevention Trial (SELECT) of the endometrial cancer. His research is funded the initiation of PDA, which may eventually is co-principal investigator (co-PI) for the ed from NYS. SCOPE was developed, in and vitamin E can prevent prostate cancer. Southwest Oncology Group (SWOG), by the National Institute of Environmental be useful in developing diagnostic and National Health Lung and Blood Institute part, to address some of the needs identi- The trial is led by Iris Granek, MD. where Stony Brook is a major contributor. Health Sciences. Dr. Shibutani and col- therapeutic tools for people with HP who (NHLBI) Women’s Health Initiative (WHI) fied as a result of an NCI-funded project, With approval of SWOG, participants in leagues hope to discover biochemical develop PDA. A proliferation of cells in the Clinical Center at Stony Brook. The nation- conducted by Dr. Lane, attempting to re- M. Cristina Leske, MD, MPH, and Barbara the SELECT trial are invited to participate causal mechanisms, then develop new and pancreatitis mouse model that appears to al WHI Clinical Trial and Observational duce barriers to colorectal cancer screen- Nemesure, PhD, are conducting a three- in the database; 70 have already enrolled. safer anti-estrogen agents. Dr. Shibutani be a progression toward cancer has been Study are having a profound effect on med- ing and to determine to what extent inter- year epidemiological study of environmen- The Database Project involves Preventive identified some genetic and toxic changes identified. These cell changes depict very ical practices following the findings of its active continuing medical education pro- tal and genetic risk factors for prostate and Medicine’s Division of Epidemiology and associated with tamoxifen-induced en- early stage PDA and indicate a potential post-menopausal hormone trials. Major grams influence the frequency of colorec- breast cancer in the African-Caribbean the General Clinical Research Center dometrial cancer. Research in rats and link between the inflammatory process outcomes studied are breast and colorectal tal cancer screening in primary practices population of Barbados. Information has (GCRC). John S. Kovach, MD, director, primates suggests that the carcinogenic and cancer. The next research phase will cancer, cardiovascular disease and fracture that serve multi-ethnic and underserved been amassed on more than 500 people LICC and acting chair, Preventive Med- action of tamoxifen occurs from mutations observe the evolution of pancreatitis to due to osteoporosis. Outcomes of the di- populations. The initiative involves collabo- with cancer and 650 control participants, icine, is the PI; co-investigators are Erin induced by DNA adducts derived from its early cancer in this model and find genetic etary modification and the calcium and ration among the Department of and genetic analyses is being conducted. O’Leary, PhD, and Elinor Schoenfeld, metabolites. In the body, tamoxifen is con- markers that dictate this disease process. 32 33

CANCER CARE AT STONY BROOK UNIVERSITY HOSPITAL ANNUAL REPORT 2005

In other research involving chronic pan- ing the blood samples of 250 healthy methodologically sound manner. Major creatitis, Howard C. Crawford, PhD, donors, none of the samples showed a areas of responsibility include protocol Pharmacological Sciences, is attempting presence of tumor cells, thus indicating no support services, such as activation and RESEARCHER INVESTIGATES A SUPER-POTENT to better understand the molecular basis of false positive results. Dr. Chen expects to monitoring, data management and provid- ASPIRIN TO PREVENT COLON CANCER pancreatic cancer in an effort to discover continue testing the cell-separation tech- ing research nursing support. early detection methods and novel thera- nology with blood samples from Stony pies. Focusing on an enzyme (MMP-7) Brook patients and others to confirm the The Cancer Clinical Trials Office provides expressed in high frequency in pancreatic validity of the diagnostic and staging tool. access to state-of-the-art cancer treatment cancer and chronic pancreatitis in mice, The cancer-cell separation method is also through involvement in a growing number not only provide advanced care for pa- allergic reactions, gastrointestinal bleed- Dr. Crawford is testing the involvement being tested as a diagnostic for ovarian and of interdisciplinary clinical trials. For over As Basil Rigas, MD, tients but also conduct research in an ing and kidney damage, all of which can of MMP-7 in multiple mouse models and lung cancers, both of which do not have a decade, it has participated in the Eastern and professor of effort to discover novel treatments for sometimes prove fatal. By coupling to studying how chronic pancreatitis may standard early detection methods. The Cooperative Oncology Group, the disease and ways to eradicate its occur- aspirin a moiety that releases nitric oxide, lead to pancreatic cancer in these animals. technology may be helpful in diagnosing Children’s Oncology Group, and the Medicine, puts it, rence—is a top priority. the resulting “nitroaspirin” retains as- and staging lung cancer because the National Surgical Adjuvant Breast and “Stony Brook is pirin’s therapeutic effects while avoiding Wen-Tien Chen, PhD, Department of method shows promise for improving the Bowel Project, as well as phases I, II and One example of research that has pro- its undesirable side effects. “Nitroaspirin Medicine, with support from a four-year sensitivity of lung biopsies, since lung tis- III pharmaceutical and in-house therapeu- undergoing a ‘sea gressed from theory to laboratory testing has been modified to release nitric oxide, $3.8 million NCI grant awarded in 2004, is sue is often watery and difficult to biopsy. tic research programs. Greater access to change’ with respect and has now moved to the clinical trials which has been shown to have numerous developing a technology that separates In 2004, Dr. Chen began collaborating with cancer cooperative group trials has been phase is Dr. Rigas’ study of a super-potent, positive effects within the cardiovascular circulating tumor cells from blood samples Stony Brook’s lung cancer specialists to established by participation in the NCI- to cancer care and nitric oxide-donating aspirin, or “nitro- and respiratory systems in people,” says of patients with cancer with solid tumors. use the technology for lung biopsies, as sponsored Clinical Trials Support Unit. research.” aspirin,” as preventive therapy for colon Dr. Rigas. And, most encouraging is the The technology shows promise for clinical well as to begin developing a lung cancer The office is a center for information and cancer. While early study results are fact that laboratory results have shown applications, including prediction of prog- diagnostic tool based on a blood test. education on investigational treatment for Dr. Rigas recently stepped into the role of promising, a long road of research lies that nitroaspirin is hundreds of times nosis and determining treatment options clinical cancer services for the LICC and chief of the Division of Cancer Prevention, ahead. However, preliminary results more potent than traditional aspirin in for metastatic disease. It also may be an in- Created jointly by the hospital and the community oncologists. Approximately 80 a position created in 2004 by Benjamin were compelling enough for Stony Brook inhibiting the growth of colon cancer cells dicator for early-stage cancer, a long-term School of Medicine, a Frozen Tissue Bank protocols are available to patients with dif- Luft, MD, chair of the Department of University Hospital clinicians from the di- in cell cultures and has been effective in goal of the research. The grant further began operating in 2004 to provide investi- ferent types of cancer. Research nurses co- Medicine, in response to the hospital’s visions of Gastroenterology, Hematology/ preventing colon cancer in laboratory advances Dr. Chen’s research involving gators with normal and abnormal human ordinate research activities and provide ad- increased emphasis on cancer prevention. Oncology, and Surgical Oncology to begin animals as well. collaboration with clinicians at the LICC tissue and blood for studies on the nature vocacy, care and education for patients on A virtual newcomer to Stony Brook with a working with Dr. Rigas and his colleagues and the GCRC, who provide blood and and cause of human cancers. Youjun Hu, cancer protocol treatment. highly regarded reputation as a successful to explore the efficacy of this new therapy. The most dramatic advances in the fight tissue samples of patients with gastroin- MD, Pathology, directs the tissue bank medical scientist and years of experience The National Cancer Institute has ap- against cancer revolve around early detec- testinal cancers, mainly pancreatic and and works with cancer surgeons to attain Over the past several years, the Cancer working at Ivy League institutions, Dr. proved funding in the amount of $3.2 tion and the discovery of new treatments, colorectal cancers. As a joint venture with tissue. Tissue samples are derived from Clinical Trials Research Program has Rigas sees here an academic medical million to support clinical trials at Stony prevention and potential cures. It is Stony Brook University, Dr. Chen has material not needed for clinical purposes. expanded to include prevention trials. As a center that has earned its place as one of Brook, the only site for an NIH-funded known that all colon cancers begin as established a biotechnology company fo- Patient confidentiality is maintained and designated site for the Study of Tamoxifen the best in New York, and among one of study of this type, to determine the effec- aberrant crypt foci (ACF), the earliest rec- cusing on commercializing cell separation patients give consent before banking any and Raloxifene (STAR), Stony Brook the best in the country. tiveness and safety of nitroaspirin for ognizable lesions. These ACF can then technologies in the form of blood tests for tissue specimens. Nearly $300,000 was University Hospital has offered patients in people at risk for developing colon cancer. progress to polyps, which in turn can be- cancer diagnosis. The technology is based awarded from the Health Resources and Suffolk County options for breast cancer The sea change Dr. Rigas speaks of is According to the American Cancer Society come cancerous. The ability for on the theory that tumor cells invading the Services Administration to acquire special- prevention. Additional expansion provides evidenced almost everywhere throughout more than 145,000 new cases of colorectal researchers to observe colon lesions at blood are a key reason why metastases ized equipment for the bank. research programs for leukemia, lym- the hospital. New leadership with a vision cancer are diagnosed in the United States the ACF stage is key. Colon cancer can occur, which frequently leads to poor out- phoma, bone marrow transplant and toward the future is literally rebuilding each year and more than 56,000 Ameri- take years to develop, with studies of come and death in patients with cancer. selected autoimmune diseases. Resources the hospital to elevate it new heights. cans die of the disease annually. benign polyps usually taking two to three A team of clinicians and researchers from can be accessed through the Stony Brook Cancer Clinical New facilities are being designed and years of observation. What will help expe- the LICC, GCRC and the biotechnology University Hospital website and through built to better provide seamless delivery Traditional aspirin has been shown in dite the study of nitroaspirin, also known company have used several blood test Trials Office the National Cancer Institute’s electronic of care to patients; the acquisition of inno- clinical studies to prevent certain cancers as “superaspirin,” as a therapy is the avail- prototypes to detect the presence of more and print media. Program leaders are vative equipment for optimum diagnostics and reduce recurrence. But, as Dr. Rigas ability of a highly innovative “super-endo- than 100 tumor cells from 95 percent of the he Cancer Clinical Trials Office as- Patricia Hentschel, MS, NP; research and treatment is ongoing; and, most im- emphasizes, there are two glaring prob- scope.” Using this instrument, which in a blood samples taken from 250 patients sists Long Island Cancer Center nurses, Margaret Bayard, RN, Gerty portant, recruitment of outstanding phys- lems with using aspirin; namely, it is effec- sense is part microscope and part endo- with adenocarcinomas of the ovary, pan- (LICC) investigators in developing Fortune, RN, June Giardelli, RN, Kim T icians and scientists who work as clini- tive, at most, in only half who take it, and scope, physicians can perform a tech- creas, colon, prostate, breast and lung at and completing scientifically valid clinical Rauso, RN; assistant, Lydia Reveron. cians and in laboratories—experts who it causes adverse side effects, such as nique called magnifying endoscopy that stages III or IV of disease. When compar- trials in an organized, cost-effective and

34 35

CANCER CARE AT STONY BROOK UNIVERSITY HOSPITAL ANNUAL REPORT 2005

Dr. Basil Rigas with Dr. Marie Gelato

provides a 150-fold magnified view of ed to establish eligibility. A pilot study is is also a site for training healthcare profes- lesions inside the colon. In this way, currently underway to determine the sionals in clinical research and its location changes in ACF can be detected and absorption, distribution, metabolism and at Stony Brook University Hospital is vital evaluated. Dr. Rigas traveled to Sapporo, excretion of the drug, and a phase I trial to the process of translating basic science Japan last year to receive specialized train- will follow. The trial is a randomized, advances into new and improved treat- ing in the use of the magnifying endo- double-blind, parallel group, placebo- ment methods. scope, and will be teaching other physi- controlled study will ultimately involve cians how to use this advanced technique. approximately 240 participants who will Marie Gelato, MD, PhD, a professor of be divided into three groups. One group Medicine in Stony Brook’s School of In upcoming clinical trials, magnifying will receive 400 milligrams of nitroaspirin, Medicine and the GCRC program direc- endoscopy will allow physicians to visually another group will receive 800 milligrams, tor, says, “It is a privilege for me and for observe and actually count the number and a third group will be administered a my staff to work with dedicated physi- of ACF present in the colons of those par- placebo, all over a six-month period. cians and researchers whose objective ticipating. After six months of treatment is to translate advances in basic science with the nitroaspirin or a placebo, in ac- Now that the study of nitroaspirin is into new or improved methods of patient cordance with study protocols, partici- moving forward to the clinical trials stage, care.” Dr. Rigas is equally impressed. pants will undergo a follow-up magnifying Dr. Rigas is extremely grateful for what “With Dr. Gelato’s outstanding leadership endoscopy, where researchers will com- he calls, “a tremendous resource for re- and a highly trained and skilled nursing pare the number of ACF before and after searchers and for the broader communi- staff, the services provided through the treatment. While it is never easy to predict ty”; namely, the hospital’s General Clinical GCRC are indispensable.” results in people based on results in the Research Center (GCRC). The GCRC is laboratory, Dr. Rigas has consistently one of only 79 federally funded centers of To bring about advancements in cancer found that for a high percentage of mice excellence for clinical research nation- treatment, participation on many levels is with colon cancer treatment with ni- wide. The center provides ongoing sup- necessary. Dr. Rigas emphasizes the im- troaspirin inhibited tumor growth and port for investigators to conduct research portance of a multidisciplinary approach may have prevented new tumors from in an optimal setting. Resources at the to research with involvement and input growing–all with no detectable adverse GCRC enhance clinical investigations from physicians and researchers across side effects. “Ideally, what we hope to find across every discipline at Stony Brook a broad spectrum of interests and expert- in the course of clinical trials on people,” while fostering an environment that en- ise. He also recognizes the need for the says Dr. Rigas, “is a reduction in the courages collaboration among research support of fellow physicians from in and number of ACF and that the features of scientists. The center provides assistance around the community. “We cannot ac- ACF shift to benign.” to researchers funded by federal, state complish our studies without the backing and local agencies as well as by the pri- of a community who hopefully will em- Active recruitment for the clinical trials vate sector. With its core resources brace our initiatives,” says Dr. Rigas. “Our is currently taking place. Investigators are shared by investigators, the GCRC’s facil- ultimate goal is to bring successful treat- reaching out to men and women, 50 years ities are conducive to collaboration among ments to clinical use as quickly and safely of age and older, from all ethnic groups, bench and clinical researchers. This envi- as possible, and to identify and potentially who have had colon cancer or colon ronment has enabled Stony Brook to de- eliminate cancer, thus saving lives.” polyps. Physical examinations and blood velop and maintain a nationally prominent and other laboratory tests will be conduct- roster of expert investigators. The GCRC

36 37

Quality and CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS Standards ancer registries gather information to Qualified researchers, administrators and clini- assist the healthcare community to better cians utilize cancer statistics for grant writing, Cancer Services Tumor Boards Cunderstand cancer. Data collection is research, administrative planning, quality im- Cancer performed in the Stony Brook University Hospital provement and clinical outcome measurement Quality Management activities. Through the use of updated National Multidisciplinary departmental and site-focused tumor board meetings were held Registry Cancer Registry using an electronic database Program of Cancer Registries standardization weekly at Stony Brook University Hospital in 2004 and 2005. These cancer confer- system in which 33,826 cancer case records The Cancer Services Quality Management methods and quality control programs, data are ences are a key component of our cancer program. They are integral to patient have been entered and stored since the registry’s Program works to ensure the delivery of safe, combined with the New York State Department of management and outcomes evaluation and provide a valued educational forum. inception in 1984. Case ascertainment continues effective, efficient and accessible care to meet Health Cancer Registry according to government Cases are presented for diagnostic assessment, staging, treatment planning, using methods that employ current technology or exceed patient expectations. It is part of the mandates and result in the publication of impor- retrospective review and education during all phases of care. Case presentations, and enable the inclusion of all inpatient and out- hospital’s Department of Continuous Quality tant statistics for public use. discussion and collaborative planning at tumor boards provide opportunities for patient cases at Stony Brook University Hospital. Improvement, which provides a collaboratively participation in research protocols and for consideration of new and emerging planned, systematic, hospital-wide approach to Internal requests for data for research, education, standards for patient management. Information on cancer site, stage, histology, treat- designing, measuring, assessing and improving ment, survival and epidemiological characteristics clinical outcomes and administrative planning organizational performance. Key aspects of pa- purposes have averaged 30 per year over the last It is recognized that consultative services are optimal when physician representa- is maintained in accordance with quality, security tient care and professional and administrative seven years. Participation in the American tives from diagnostic radiology, pathology, surgery, medical oncology and radia- and confidentiality standards. Lifetime follow-up is functions are evaluated to identify improvement College of Surgeons Commission on Cancer, tion oncology participate in facility-wide conferences. Other participants include actively collected on analytic cases dating back to opportunities and implement timely action plans National Cancer Data Base Annual Calls for Data representatives from pulmonary medicine, dentistry, nursing, pain management, the follow-up reference date of January 1, 1993. and process improvements. and Special Studies provides the hospital with social work, pharmacy, nutrition, physical therapy, speech and hearing, cancer Follow-up updates of hospital system encounters comparative data on the major cancer sites, in- registry and research. Faculty, residents, interns, fellows and students in all spe- are added to all records. A 91 percent successful Cancer program standards demand that services, cluding stage III lymph node, positive colon can- cialties attend and participate in discussion relevant to clinical education. The follow-up rate is currently maintained. The data care and patient outcomes be evaluated and im- cer and prostate cancer, and enables faculty to departmental and site-focused tumor boards include Breast, General Medical and is collected and managed by certified tumor regis- proved so that patients receive care comparable to assess clinical processes and outcomes using na- Surgical Oncology, Head and Neck, Brain and CNS, Leukemia and Lymphoma, trars (CTR) and trained staff who actively partici- nationwide standards. The Quality Management tionally accepted methods and standards of care. Lung, Melanoma, Pediatric, Gynecologic Oncology and Urology conferences. pate in continuing education to maintain creden- Program responds to the Cancer Committee’s Program leaders are tialing, and in professional association activities. direction in setting performance improvement Vencine Kelly, CTR, director; Margaret Stony Brook hosted the Long Island Cancer The Cancer Registry has participated in the priorities that directly affect patient care. Through Tumor Board Schedule Celestino, follow-up Registrars Association Spring Conference May American Cancer Society’s facility information the development of an Oncology Dashboard secretary; Katherine 13, 2005 providing expert faculty speakers for profile initiative since 2001. Cancer statistics are Medical and Surgical Oncology every Tuesday, 7:30 am Garistina, CTR; Kristen with the input of the Cancer Committee, Cancer published and disseminated in annual reports, Laub-Palumbo, CTR the educational program. Cancer Registry staff Clinical Service Group, Oncology Leadership Head and Neck weeks 1 and 3 and Carole Whitehead, attended the National Cancer Registrars Associa- which are distributed throughout the community. Council members, and other cancer services pro- Urology week 2 CTR. tion meeting in New Orleans, LA, April 10 Cancer registry statistical reports are used to sup- fessional staff, data are collected on selected indi- Melanoma week 2 through 14, 2005. port research and community outreach, and are cators and compared to benchmarks for analysis. presented at cancer conferences and administra- General Oncology weeks 4 and 5 Quality assessments are performed in accordance tive meetings. These reports include annual can- The program fosters a work environment that en- Gynecologic Oncology Wednesdays, 7 am, weeks 1, 2, 3, 5 with national coding standards. Cancer Commit- cer site incidence tables and site-specific studies courages the creation, assessment and redesign Lung Cancer Wednesdays, 2:30 pm, weeks 2 and 4 tee physicians meet with registry staff weekly to featuring descriptive statistics and comparative of processes and systems to achieve continuous outcomes data and have presented on cancers of Surgical Oncology Treatment Planning every Thursday, 4 pm review at least ten percent of records for data improvement in outcomes and staff performance. accuracy and completeness of documentation on the head and neck, lung, ovary, thyroid, colon and Each member of the cancer services manage- Pediatric Oncology Thursdays, 4 pm, weeks 1 and 3 cancer stage, identification of anatomic site, rectum, prostate and breast. These are posted and ment, clinical staff and support personnel play a Breast Treatment Planning every Friday, 7:30 am histology, treatment and follow-up, with discrep- may be viewed on the Cancer Registry website at role in ensuring quality of services and perform- Leukemia and Lymphoma Fridays, noon, weeks 2 and 4 ancies returned for re-assessment. Peer review www.StonyBrookHospital.com/CancerRegistry/. ance improvement. by re-abstracting case records is routinely per- formed. Coding consensus case discussions occur The program leader is William Greene, MD, associate director, Medical Regulatory Affairs. at monthly department meetings. 38 39

Professional Education in Cancer Care July 1, 2004 - June 30, 2005 AMA PRA Category 1 Site-Specific Approved by School of Medicine/Office of Continuing Medical Education Stony Brook University Reports

DATE TITLE OF LECTURE/CONFERENCE PRESENTING DEPARTMENT Oct. 2, 2004 16th Annual Conference on Mammography Office of CME Breast Cancer Nov. 6, 2004 Hand Assisted Laparoscopic Colon and Rectal Surgery Workshop Surgery reast cancer is the most seen in 2004 than the national screening mammography for early Jan. 12, 2005 Epidemiology of Gynecologic Cancers Obstetrics/Gynecology common cancer seen in benchmark. This data provided diagnosis in patient and community Jan. 12, 2005 Benign Lesions of the Breast Pathology Bfemale patients with cancer an opportunity to assess our ex- education. Jan. 12, 2005 IR Applications in Oncology Radiology at Stony Brook University Hospital perience and review our current Jan. 20, 2005 Renal Masses in Childhood Radiology annually, exceeding other female outreach programs to underserved Modalities utilized most frequently communities. in the management of breast cancer Jan. 26, 2005 Genetics of Gynecologic Cancers Obstetrics/Gynecology cancer sites by a significant per- centage. Breast cancer is the most are surgery, radiation therapy, Survey prepared by Jan. 26, 2005 Minimal Residual Disease Studies in Acute Leukemia Pathology frequently diagnosed cancer in The age 50-59 is the highest age chemotherapy and hormone thera- Brian O’Hea, MD, Feb. 2, 2005 Cancer Screening and Prevention Obstetrics/Gynecology Surgical Oncology, women. An estimated 211,240 new group at diagnosis at SBUH and py. Multidisciplinary management director, Breast Care Feb. 9, 2005 Mucinous Tumors of the Ovary Pathology cases of invasive breast cancer will NCDB. Our survey found that 31.5% and breast conservation surgery Center; and Vencine Feb. 9, 2005 Surgical Principles in Gynecologic Oncology Obstetrics/Gynecology be diagnosed in women in the US of cases managed here were less are a priority at the Stony Brook Kelly, CTR, Cancer Feb. 23, 2005 Use of Immunohistochemical Stains in Differentiating in 2005 according to the American than age 50 at diagnosis compared University Hospital Breast Care Registry Department. Clear Cell Carcinomas Pathology Cancer Society’s 2005 report. to 22% in the NCDB population. As Center. Feb. 23, 2005 Premalignant Conditions in Gynecologic Oncology Obstetrics/Gynecology we have younger patients (age < 50 ) March 2, 2005 Malignant Conditions of the Cervix and Vagina Obstetrics/Gynecology There were 427 cases of breast diagnosed with breast cancer, the Seventy-four percent of our patients younger population have available diagnosed with breast cancer have March 2, 2005 Radiation Effects in Normal Tissues: The New Formalism Radiation Oncology/Medical Physics cancer first encountered at Stony Brook University Hospital (SBUH) to them support services which in- undergone breast preservation as March 2, 2005 Visiting Professor Lecture Series in Radiation Oncology Radiation Oncology in 2004. Of those, 353 were first cludes genetic counseling at Stony an alternative to mastectomy, and March 5, 2005 Hand Assisted Laparoscopic Colon and Rectal Surgery Workshop Surgery diagnosed and/or received their Brook University Hospital. were treated with multidisciplinary March 9, 2005 Endometrial Cancers Obstetrics/Gynecology first course of treatment at Stony conservative management in 2004. March 16, 2005 Epithelial Ovarian and Fallopian Tube Cancer Obstetrics/Gynecology Brook. Seventy-four were first seen Greater than half were first diag- Our current lifetime patient follow- March 19, 2005 Urology Symposium Urology with recurrence or re-treatment. We nosed at an early stage, 24% in-situ up rate for outcome evaluation is and 37% Stage 1, compared to the 92% successful. Five-year survival at March 23, 2005 Cancer During Pregnancy Obstetrics/Gynecology compared 2004 new breast cancer patients with breast cancer patients NCDB benchmark of 17% and 40%. SBUH remains excellent at 91% vs. March 30, 2005 Ancillary Studies in Soft Tissue Tumors Pathology first seen at the hospital in 2003, This reflects the emphasis on the 78% NCDB benchmark. April 6, 2005 Development and Implementation of Helical Tomotherapy Radiation Oncology/Medical Physics and with National Cancer Data Base April 6, 2005 Visiting Professor Lecture Series in Radiation Oncology Radiation Oncology (NCDB) benchmark data on patient April 13, 2005 Treatment of Laryngeal Cancer Otolaryngology characteristics at the time of diagno- May 4, 2005 Visiting Professor Lecture Series in Radiation Oncology Radiation Oncology sis, including age, stage, and ethni- AGE AT DIAGNOSIS NCDB RACE NCDB Female Breast Cancer 2004 Female Breast Cancer 2004 May 11, 2005 Benign Disorders of the Larynx Otolaryngology city. We also looked at the type of Comparing 2003 and 2004 SBUH with NCDB Data Comparing 2003 and 2004 SBUH with NCDB Data 2003 2003 May 18, 2005 Radiation and Cancer Pathology surgery received in the first course 30% 100% of treatment. Overall the patient May 22, 2005 Hand Assisted Laparoscopic Colon and Rectal Surgery Workshop Surgery 25% population at Stony Brook is similar 80% June 1, 2005 Lessons from Childhood Cancer Radiation Oncology/Medical Physics to that from the NCDB. 20% June 1, 2005 Visiting Professor Lecture Series in Radiation Oncology Radiation Oncology 60% 15% June 2, 2005 Skin Cancer (31st Annual Family Medicine Update) Family Medicine Although the race mix is generally 40% June 2, 2005 Skin Biopsy (31st Annual Family Medicine Update) Family Medicine similar, the comparison demonstrat- 10%

June 26, 2005 Laparoscopic Workshop Urology ed there were 7% fewer minorities 5% 20%

June 29, 2005 The Thin Prep Pap Test Challenge Pathology 0% 0% 30-39 40-49 50-59 60-69 70-79 80+ White Black Asian 40 41

CLINICAL CARE COMMUNITY OUTREACH CLINICAL SUPPORT RESEARCH QUALITY AND STANDARDS SITE-SPECIFIC REPORTS

STAGE AT DIAGNOSIS NCDB

Female Breast Cancer 2004 Comparing 2003 and 2004 SBUH with NCDB Data 2003 40% 35% AGE AT DIAGNOSIS NCDB GENDER NCDB 30% Urinary Bladder Cancer 2004 Urinary Bladder Cancer SBUH Comparing 43 Cases at SBUH in 2004 vs. Comparing 43 Cases at SBUH in 2004 25% 35,152 NCDB Cases in 2001 vs. 35,152 NCDB Cases in 2001 40% 80% 20% 35% 70% 15% Bladder Cancer 30% 60% 10% 25% 50% 5% ccording to the American Stony Brook specialists provide di- (NCDB) benchmarks. Seventy per- 20% 40% 0% 0 1 2 3 4 UNKNOWN Cancer Society, there will agnosis, treatment and follow-up cent of our patients were male and 15% 30% be an estimated 63,210 new programs for patients with bladder 30% female, compared to 74% male 10% 20% TREATMENT MODALITIES NCDB A cases of bladder cancer expected to cancer. Cystoscopy is the mainstay and 26% female NCDB cases. A Female Breast Cancer SBUH 5% 10% SBUH vs. NCDB occur in 2005. Bladder cancer is the of diagnosis. Bladder cancers, espe- larger proportion of patients treated 0% 0% 100% fourth most common malignancy cially if they are superficial, may be here were younger than the national 30-39 40-49 50-59 60-69 70-79 80+ Males Females affecting American men and the treated via cystoscopic resection. average at diagnosis. Twenty-five 80% ninth most common malignancy Further treatment is determined by percent were age 59 or younger at affecting American women. Bladder the stage and grade of the cancer. diagnosis at SBUH, compared to 60% cancer incidence rates among men Patients may be treated with chemo- 17% in the NCDB. Representation RACE NCDB STAGE AT DIAGNOSIS NCDB 40% and women combined leveled off therapy or immunotherapy placed of minority patients at SBUH was 4% Urinary Bladder Cancer 2004 Urinary Bladder Cancer 2004 from 1986 to 2001, after increasing directly into the urinary bladder. less than benchmark data. Distribu- Comparing 2004 SBUH with NCDB Data Comparing 2004 SBUH with NCDB Data 20% by 0.7% per year from 1975 to 1986. Patients with muscle-invasive cancer tion of AJCC TNM stage at diagno- 100% 50% Overall, bladder cancer incidence may be candidates for surgical re- sis mirrored benchmark data for 0% 80% 40% Surgery Radiation Chemo Hormones is about four times higher in men moval of the bladder with creation of non-invasive bladder cancer case, than in women and two times higher a neo-bladder from a segment of in- with both SBUH and NCDB show- SURGERY NCDB 60% 30% in whites than African Americans. testine. Select patients may be candi- ing 47% of newly diagnosed patients Female Breast Cancer SBUH SBUH vs. NCDB An estimated 13,180 deaths from dates for a partial cystectomy provid- having in-situ stage bladder carci- 40% 20% 80% bladder cancer will occur in 2005. ed the tumor is confined to one area noma at diagnosis. SBUH recorded 70% of the bladder. For all patients, early 14% of patients with Stage 4 at diag- 20% 10% 60% The most common risk factor for diagnosis is important as this may nosis, compared to 6% nationally, 0% 0% 50% bladder cancer is cigarette smoking allow more successful treatment. and demonstrated fewer with un- White Black Asian 0 1 2 3 4 UNKNOWN 40% and is found in at least 50% of cases. With better diagnosis and improved known stage by 4%. Twelve percent 30% Cigarette smoking increases the risk treatment, survival for bladder can- were treated with total complete 20% of developing bladder cancer by two cer patients has improved from 73% cystectomy compared to 7% in the 10% to four times. Cessation of cigarette to 82% from 1974 to 2000. NCDB. Five-year survival at SBUH SURGICAL TREATMENT NCDB 5-YEAR SURVIVAL SBUH 0% smoking and increasing fluid intake closely mirrored the NCDB bench- Urinary Bladder Cancer Urinary Bladder Cancer Breast Conservation Surgery Complete Mastectomy SBUH NCDB may decrease the risk of developing There were 64 cases of bladder can- mark data at 59% vs. 57%. SBUH vs. NCDB 237 SBUH cases 1999-2004 vs. 70,906 NCDB cases 1995-1996 100% 100% 5-YEAR SURVIVAL NCDB bladder cancer. Other risk factors cer first encountered at Stony Brook Female Breast Cancer All Stages SBUH include exposure to aniline dyes and University Hospital (SBUH) in 2004. 1,752 SBUH Cases 1999-2004 vs. 18,943 NCDB Cases 1995-1996 80% benzene as well as a history of pre- Forty-three were newly diagnosed Survey prepared by Howard Adler, 100% vious pelvic irradiation. Bladder and treated and 18 had recurrence MD, Department of Urology and 80% Vencine Kelly, CTR, Cancer Registry 60% cancer is rarely silent and usually or re-treatment. Statistics on age, Department. presents with symptoms. These gender, stage, race, surgical treat- 40% 60% symptoms include hematuria as well ment and survival was compared 80% as urinary urgency and frequency. with the National Cancer Data Base 20%

0% 40% Local Excision Partial cystectomy Complete cystectomy 1 YR 2 YR 3 YR 4 YR 5 YR

60% 1 YR 2 YR 3 YR 4 YR 5 YR 42 43

Cancer Statistics The Cancer Committee CANCER STATISTICS AT STONY BROOK UNIVERSITY HOSPITAL, STONY BROOK, NY Cancer Site Distribution in 2004 by Case Type, Sex and TNM Stage The Cancer Committee is the Theodore Gabig, MD Medical Oncology/Hematology designated multidisciplinary Committee Chair Patient Type Gender Stage Groups body for the review of cancer Howard Adler, MD Urologic Oncology PRIMARY SITE 2004 TOTAL New Re-tx Male Female 0 I II III IV Unk N/A care services at Stony Brook ALL SITES 2310 1817 493 950 1360 161 543 394 257 305 311 339 University Hospital. It plays a Teresa Beutel Healthcare Teleservices ORAL CAVITY 61 54 7 43 18 2 6 7 11 23 11 1 vital role as an administrative Sabra Boughton, NP,PhD Patient Education Lip 32121 0001020 advisory committee in the Rose Cardin, RN Nursing Administration Tongue 18 16 2 14 4 2 1 1 4 7 3 oversight and development of Eva Chalas, MD GYN/Oncology Leadership Council Oropharanyx 1 1 0 1 0 0 0 0 1 0 0 0 Stony Brook’s cancer services. Hypopharanx 4 4 0 3 1 0 0 0 2 1 1 0 Antoinette Forster, NP Palliative Care Theodore Gabig, MD, was Other 35 31 4 23 12 0 5 6 3 15 5 1 Jeannie Gaspard, RN Oncology Nursing appointed committee chair in DIGESTIVE SYSTEM 246 181 65 133 113 5 41 36 43 65 54 2 William Greene, MD Quality Management Bibliography Esophagus 23 17 6 21 2 0 0 4 7 6 6 0 2005. Loretta Gvazdinskas Hospital Administration Cancer Facts and Figures, 2005,American Stomach 30 20 10 20 10 0 8 3 2 7 10 0 Cancer Society,Atlanta, GA. Colon 75 52 23 34 41 1 18 9 10 22 15 0 The Committee is comprised Patricia Hentschel, NP Clinical Trials Rectum 42 34 8 24 18 0 8 8 15 5 5 1 of physician representatives Youjun Hu, MD Pathology Cancer Incidence in North American Anal Canal 9 5 4 2 7 4 1 2 0 0 2 0 from the medical, surgical and 1997-2001,Volume I: Incidence,Volume II: Martin Karpeh, MD Surgical Oncology Mortality, North American Association of Liver 19 15 4 11 8 0 2 6 2 2 7 0 diagnostic clinical areas with Pancreas 35 26 9 14 21 0 3 2 3 20 7 0 Vencine Kelly, CTR Cancer Registry Central Cancer Registries, Inc. Other Gastrointestinal 13 12 1 7 6 0 1 2 4 3 2 1 representatives from supporting departments involved with the John Kovach, MD Long Island Cancer Center Director National Cancer Data Base, Cancer Statistics RESPIRATORY SYSTEM 291 225 66 153 138 1 62 28 60 109 30 1 Stefan Madajewicz, MD Medical Oncology by Disease Site 2001: Breast, Bladder, Nasal/Sinus 2 2 0 2 0 00 101 00 care of patients with cancer. Commission on Cancer, Chicago, IL. Larynx 32 24 8 24 8 1 6 6 3 13 3 0 Cancer Committee recommen- Seth Mankes , MD Diagnostic Radiology Surveillance, Epidemiology and End Results Lung 253 196 57 125 128 0 54 21 57 95 25 1 dations are made directly to the JoAnn McCaslin, LCSW Social Work Program 1975-2001, Division of Cancer Other Respiratory 4 3 1 2 2 0 2 0 0 0 2 0 hospital’s Medical Board and Robert Parker, MD Pediatric Oncology Control and Population Science, National BLOOD & BONE MARROW 107 70 37 63 44 0 1 0 0 0 1 105 impact the direction of the Jedan Phillips, MD Family Medicine/ Cancer Institute, Bethesda, MD. Leukemia 59 44 15 33 26 0 0 0 0 0 0 59 cancer program. Multiple Myeloma 26 16 10 20 6 0 1 0 0 0 0 25 ACOS Liaison Physician Commission on Cancer, Cancer Program Other Hematopoietic 22 10 12 10 12 0 0 0 0 0 1 21 Charles Robbins, DSW Social Work Standards, 2004, Chicago, IL. BONE 64242 0010221 Maisie Shindo, MD ENT Surgery CONNECT/SOFT TISSUE 23 21 2 8 15 0 10 1 0 4 7 1 Lori Tischler, RN Cancer Helpline SKIN 88 73 15 53 35 15 40 11 3 4150 Cathy Tuppo, RPT Physical Medicine & Rehabilitation Melanoma 80 67 13 49 31 15 39 10 3 4 9 0 Scot Weber, RPH Pharmacy Other skin 8 6244 0110060 Tamara Weiss, MD Radiation Oncology BREAST 427 353 74 1 426 90 146 97 42 14 38 0 The 2005 Cancer Care Annual Report FEMALE GENITAL 266 228 38 0 266 30 89 24 51 20 45 7 was developed by the Cancer Committee Cervix Uteri 42 41 1 042128863 50 and published by the Office of Publications, Endometrium 106 94 12 0 106 0 62 10 17 8 7 2 Stony Brook University Hospital, Ovary 86 66 20 0 86 0 14 4 25 8 30 5 Stony Brook, New York, October 2005. Vulva 21 16 5 0 21 14 3 2 0 0 2 0 StonyBrookHospital.com Other Female Genital 11 11 0 0 11 4 2 0 3 1 1 0 MALE GENITAL 226 160 66 226 0 1 10 163 8 9 34 1 Contact Numbers Prostate 211 146 65 211 0 0 0 163 8 8 32 0 Phone numbers are in the 631 area code unless otherwise stated. PUBLICATIONS DIRECTOR Testis 12 11 1 12 0 1 9 0 0 0 2 0 Cancer Helpline 800.862.2215 Lung Cancer Evaluation Center 444.2981 Michele Vallone Other Male Genital 33030 0100101 Cancer Registry 444.9844 Neurosurgical Oncology 444.1210 ASSOCIATE PUBLICATIONS DIRECTOR URINARY SYSTEM 110 79 31 73 37 17 22 7 8 24 32 0 and FEATURE WRITER Urinary Bladder 61 43 18 40 21 17 8 5 5 9 17 0 Carol M. Baldwin Breast Care Center 444.4550 Nursing 444.2780 Jo-Ann Oakes Kidney 49 36 13 33 16 0 14 2 3 15 15 0 Chaplaincy 444.8157 Nutritional Services 444.1441 BRAIN & CNS 134 112 22 64 70 0 0 0 0 0 0 134 Chemotherapy Pharmacy 444.2318 Pain Service 444.4234 CONTRIBUTING RESEARCH WRITER Brain (Benign) 11 10 1 5 6 0 0 0 0 0 0 11 Child Life Program 444.3840 Patient Education Services 444.5263 Greg Filiano Brain (Malignant) 45 38 7 26 19 0 0 0 0 0 0 45 Dermatology 444.3843 Pediatric Oncology 444.7720 PUBLICATIONS COORDINATOR Other CNS 78 64 14 33 45 0 0 0 0 0 0 78 Diagnostic Radiology 444.2424 Physical and Lymphedema Therapy 444.4240 Casey Ellin ENDOCRINE 163 140 23 46 117 0 87 5 15 13 4 39 DESIGN Thyroid 124 107 17 30 94 0 87 5 15 13 4 0 Gynecologic Oncology 444.9416 Preventive Medicine 444.2190 Panarama Design Other Endocrine 39 33 6 16 23 0 0 0 0 0 0 39 Head and Neck Oncology 444.3993 Radiation Oncology 444.2200 LYMPHATIC SYSTEM 113 78 35 61 52 0 29 14 13 16 34 7 HealthConnect® 444.4000 Social Work Services 444.2552 PHOTOGRAPHY Hodgkins Lymphoma 18 13 5 9 9 0 5 4 2 0 7 0 Hematology/Oncology 444.1727 Surgical Oncology 444.1793 Peter Finger Non-Hodgkins Lymphoma 95 65 30 52 43 0 24 10 11 16 27 7 Medical Photography: John Griffin, Jeanne Long Island Cancer Center 444.9340 Urologic Oncology 444.6282 Neville, Marylou Stewart, pages 11, 13, 19, UNKNOWN PRIMARY 35 27 8 17 18 0 0 0 0 0 0 35 20, 30 OTHER/ILL-DEFINED 14 12 2 5 9 0 0 0 3 2 4 5 PRINTING 44 This report includes in-situ cervix and intraepithelial neoplasia cases Castlereagh, Inc.

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