CAYUGA CANCER CENTER ANNUAL REPORT 2018

Quality Cancer Care Close to Home CHAIRMAN’S REPORT Expanding our care team and new therapies enhance treatments for our patients

Cayuga Cancer Center enhanced patient care in 2018 diagnosing and staging of lung cancer. with improvements in diagnosis, treatment, access to care, A physician uses ultrasound to view and support. Among the highlights: difficult-to-reach areas of the lung and • Several new surgeons joined the Cayuga Cancer then guides a thin needle to suspect Center with expertise in minimally invasive surgery. lymph nodes to withdraw biopsy samples. • Renovations and facility improvements were completed No incision is made, so patients recover to improve patient access. quickly and usually go home the same Timothy Bael, MD • We continued to implement new treatment protocols day as the procedure. Gold-Level Commendation with immunotherapies and other multi-targeted biologics to treat cancer more effectively. Advanced treatment options in accreditation • 3D mammography and other advanced imaging Targeted therapies and the role of immunotherapy in cancer treat- techniques combined with image-guided biopsies are ment at Cayuga Cancer Center continued to expand and improve honors Cayuga Cancer Center Charles Garbo, MD allowing earlier diagnosis of multiple cancers, when patient outcomes in 2018. for a third time therapies are most effective. Through our affiliation • Planning began to replace our radiation department’s with Roswell Park linear accelerator in 2019 that will allow improved Comprehensive Cancer We were honored in 2018 to receive our third Our oncology nurse navigation and survivorship pro- access to types of targeted radiation therapy patients Center in Buffalo, our consecutive, three-year term of accreditation with Gold- gram has been guiding patients since 2011 through all now travel to Rochester or Buffalo to receive. For patients access clinical Level Commendation from the American College of Surgeons phases of their care from early diagnosis, treatment, and more details, see page 8. trials and new therapies Commission on Cancer. Since our program began in 1985, post-treatment care. The for cancers that have not responded to other treatments. An it has been continuously accredited by the Commission and nurse navigation team and New practitioners expand cancer care example is the development of adoptive T cell therapy, or CAR-T. has twice received the Commission’s Outstanding Achieve- social worker provide care New practitioners with the Cayuga Cancer Center are With this innovative immunotherapy, T cells from the immune ment Award. A Gold-Level Commendation is the highest and support for both pa- expanding local treatment for multiple cancers including system are removed from a patient’s blood and genetically modified designation given to cancer programs and recognizes that tients and their families. The breast, prostate, and gastrointestinal cancers. Caitlin Foor- to target a cancer protein. The modified cells are returned to the the Cayuga Cancer Center meets all standards set by the team advocates for patients, Pessin, MD, has come to Ithaca from Strong Memorial in patient where they track down and destroy cancer cells. Roswell commission and ensures that patients receive high-quality collaborates with caregivers Rochester where she was a chief fellow in gastroenterology Park has been a pioneer in developing immunotherapy. CAR-T oncology, radiation, and surgical cancer care. and health-care providers, and hepatology. Adam R. Riordan, DO, was most recently the therapy was originally used in advanced leukemia, and researchers The most recent Commission on Cancer accreditation links patients to community chief fellow in the gastroenterology department at Millcreek are working to expand its use to treat other types of cancer. report noted: resources, coordinates patient care, and educates patients Community and a clinical instructor of internal and the community about cancer issues. Our partnerships “ Cayuga Medical Center has been a COC-accredited medicine in the Division of Gastroenterology at LECOM Improving mammogram technology with the Cancer Resource Center of the and Health, both in Erie, PA. Dr. Foor-Pessin and Dr. Riordan are During 2018 a new generation of mammogram technology hospital for 30+ years and has received the the American Cancer Society have done an outstanding now with Gastroenterology Associates. providing earlier breast cancer detection was installed throughout Outstanding Achievement Award during its past job of assisting patients with finding support groups and Denise Lee, MD, and Gregory G. Ripich, MD, both with the Cayuga Health System. two surveys. They take great pride in this but information during and after their cancer treatments. Surgical Associates of CMA, also began treating patients Digital breast tomosynthesis, or 3D mammography, uses a are not complacent. It is apparent that continuous at Cayuga Cancer Center in 2018. Dr. Lee graduated low-dose x-ray system and computer reconstructions to create Lung cancer detection performance and quality improvement is one from Harvard University before attending medical school three-dimensional images of the breasts. Numerous studies have Our program to improve the detection and early treatment of their guiding principles. The Hospital Senior at the University of Florida. She then went on to UCLA for shown 3D mammography is 20 to 60 percent more accurate in of lung cancer in our community has rapidly expanded surgical training and spent two years in medical research detecting invasive breast cancer when compared to 2D mammog- Leadership is very involved and supportive of the since it began in 2015. During the last three years, more earning multiple awards including an NIH training grant. raphy. In addition to improving the accuracy of the diagnosis, Cancer Program and takes great pride in its success.” than 1,000 patients were screened for lung cancer, so Dr. Lee recently completed a fellowship in endocrine sur- 3D imaging leads to fewer follow-up studies and false alarms, the disease can be detected early before the onset of gery at Presbyterian Hospital/Columbia University reducing patient anxiety and exposure to radiation. Improving survivorship care symptoms when treatments are most effective. Our com- Medical Center. Dr. Ripich is a graduate Along with Cayuga Cancer Center’s clinical care excellence, munity’s primary care physicians’ attention to patients with over 20 years of experience in robotic and minimally Improved patient care locations the Commission cited the Center’s survivorship program having a history of smoking tobacco can be credited to invasive surgery. He was most recently at St Joseph’s Renovations completed in our East Campus offices at 10 as a notable area of high-quality patient care. The program the program’s success. They have taken the lead in asking Hospital in Syracuse where he trained other surgeons in Arrowwood Drive in 2018 allow more patients to schedule assists patients completing cancer treatments in making patients about their tobacco use and urging current and robotic surgery. His areas of clinical interest include minimally chemotherapy at an enlarged infusion suite and see their oncol- the transition to the next phase of their lives. Our nurse former smokers to have a low-dose computer tomography invasive colorectal surgery, colonoscopy, and endoscopy. ogists at that location. Our newest offices at 6 Euclid Avenue in navigators give patients survivorship care plans that are screening for lung cancer. Cortland, provide patients convenient care close to their home. a comprehensive record of their cancer history and treat- Minimally invasive lung cancer biopsy ments. The plans also provide recommendations on future Charles Garbo, MD Cayuga Medical Center has fully integrated endobronchial Timothy E. Bael, MD checkups, cancer tests, possible long-term effects of their Chairman, Cancer Committee; ultrasound (EBUS), a diagnostic procedure that improves the Medical Director, Cayuga Cancer Center treatment, and suggestions for staying healthy. Cancer Liaison Physician to the Commission on Cancer

2 CAYUGA MEDICAL CENTER ON THE COVER: Kristen Sad of Ithaca completed her breast 2018 CANCER ANNUAL REPORT 3 cancer treatments at the Cayuga Cancer Center in 2018. MEET SOME OF OUR ONCOLOGY NURSES Care and support Jennifer Fuller, RN, BSN, OCN Kara Gowan, RN, BSN, OCN eased her cancer journey Oncology Nurse Manager Outpatient Oncology Nurse Education: Bachelor of Science in Nursing, Education: Bachelor of Science in Keuka College, Associate Degree Applied Nursing, Mansfield University of Science in Nursing, Tompkins Cortland Pennsylvania (Mansfield, PA) Community College (Dryden, NY)) Certification: Registered Nurse, Certification: Registered Nurse, Oncology Oncology Certified Nurse, Oncology Certified Nurse, Oncology Nursing Society Nursing Society certification for certification for chemotherapy and biotherapy chemotherapy and biotherapy

Jennifer Fuller is a member of the interdisciplinary cancer care Kara Gowan has been an oncology nurse at the Cayuga team and serves as oncology nurse manager. She supervises and Cancer Center since 2015. Earlier, she worked in oncology, participates in multiple areas of patient care directives including ENT and facial plastic surgery nursing care in New York and the Commission on Cancer and chemotherapy care plans. She has Kentucky medical facilities. At the Cayuga Cancer Center, worked as a team member on initiatives for hospital policy and she works primarily in the infusion center monitoring and procedures, oncology community event planning, and nursing assessing patients, administering chemotherapy/biotherapy, quality standards. and caring for patient needs that arise during treatment.

Robin Anderson-Eastburn, RN Marie Smith, RN, BSN Outpatient Oncology Nurse Outpatient Oncology Nurse Education: Associate Degree Applied Education: Bachelor of Science in Science in Nursing, Tompkins Cortland Nursing, Binghamton University, hen Kristin Sad noticed a lump in her right breast and that is where Ithaca excels,” Kristin says. Community College (Dryden, NY) Decker School of Nursing W Certification: Registered Nurse, (Binghamton, NY) in June 2017, she was not surprised that the diagnosis would She found Dr. Campbell’s approach to cancer treatment Oncology Nursing Society certification Certification: Registered Nurse, be cancer. Her maternal aunts had gotten the same diagnosis also considered the care and support Kristin would need for chemotherapy and biotherapy Oncology Nursing Society certification when they reached their 60s, the same age when Kristin no- in other areas of her life including family, work, and acting for chemotherapy and biotherapy ticed her lump. Within a few days, a mammogram imaged the with Ithaca-area theater groups. lump and a biopsy with a clinical diagnosis of stage 2 breast “I always felt she focused on me as a person and not just Robin Anderson-Eastburn has been an oncology nurse at the Marie Smith joined the Cayuga Cancer Center as an oncology cancer confirmed Kristin’s suspicion. a patient with cancer. She took time to find out about my Cayuga Cancer Center since 2000. She is a radiation oncology nurse in 2013. Earlier, she was an oncology nurse at While Kristin was not surprised, the confirmation that she interests,” Kristin recalls. nurse, assisting physicians and arranging care for patients. and an infusion clinic in Pennsylvania and New England. At had cancer was frightening and the beginning of six months Betty McEver, RN, BSN, OCN, CRN, a nurse navigator Earlier, she administered chemotherapy and biotherapy to the Cayuga Cancer Center, she monitors and assesses patients, of treatment that would be life changing. with the Cayuga Cancer Center, anticipated Kristin’s concerns infusion center patients. She serves on Cayuga Medical Center’s administers medications including chemotherapy, and coordi- Cancer Committee as the Clinical Research Coordinator. nates care with other health-care professionals. “It really smacks you,” Kristin says. “In the beginning, there and prepared her for how chemotherapy and radiation were times I was really scared. I cried, and my husband would treatments might affect her. hold me close. But, having cancer changed me. I am more “I would lose my hair, lose interest in food, and just not D. Chorba, RN, OCN Jilian Wheeler, RN, OCN appreciative of the good things in my life and don’t get dis- feel like myself while having chemo every three weeks Outpatient Oncology Nurse Oncology Service Line Charge Nurse tracted by small annoyances.” for 18 weeks. Nurse Betty, Jilian Wheeler [RN, OCN], and Education: Bachelor of Science in Education: Associate Degree Applied Shortly after her diagnosis, Kristin saw Julie Campbell, MD, other nurses in the chemo suite helped me get through Sociology/Anthropology, Elizabethtown Science in Nursing, Tompkins Cortland College (Elizabethtown, PA); Associate Community College (Dryden, NY) an oncologist at the Cayuga Cancer Center, who has clinical some difficult days,” Kristin says. Degree Applied Science in Nursing, Tompkins Certification: Registered Nurse, and research interests in breast cancer. She reviewed the cancer Kristin also learned about the range of assistance and Cortland Community College (Dryden, NY) Oncology Certified Nurse, Oncology and treatment options with Kristin and encouraged her to seek support programs at the Cayuga Cancer Center and at the Certification: Registered Nurse, Oncology Nursing Society certification for another doctor’s opinion. After seeing Kristin and checking her Cancer Resource Center of the Finger Lakes. She valued Certified Nurse, Oncology Nursing Society chemotherapy and biotherapy medical records, the second oncologist recommended the same having so many options but found herself relying on her certification for chemotherapy, and biotherapy treatment plan that Dr. Campbell had presented. network of friends and family for help and support. D. Chorba has worked as an oncology nurse at the Cayuga Cancer Jilian Wheeler is the oncology charge nurse at Cayuga Cancer Getting a second opinion made Kristin more confident in After completing chemotherapy, Kristin had five weeks Center’s Main and East campus since 2011. She provides patient Center where she has worked since 2012 in several positions. her treatment decision. On July 27, Cora Foster, MD, removed of radiation therapy and finished her treatments in January care and education, administers chemotherapy, and monitors In her current role, she coordinates day-to-day treatments Kristin’s tumor and three lymph nodes in a day-surgery 2018. By March she was back at work at Elmira Savings Bank patients. She is particularly interested in maintaining current in the chemotherapy suite, provides patient education, and lumpectomy procedure at Cayuga Medical Center. By late after- in Ithaca where her supportive manager and co-workers knowledge on new and developing treatment options to provide mentors new nurses to the service line. noon, Kristin’s family was taking her home to rest and recover. helped her take a six-month leave. patients with the most advanced and highest standard of care. “I found that treatment protocols for a specific type of “I have been fortunate. Cancer is scary, but I had a lot of cancer are similar. It’s the support system that can be different, wonderful people to help me on that journey,” she says.

4 CAYUGA MEDICAL CENTER 2018 CANCER ANNUAL REPORT 5 RAISING CANCER AWARENESS IN 2018 COMMUNITY NETWORK

Ties to other community agencies, such as the American Cancer Society, Hospicare and Palliative Care Services of Tompkins and Cortland Counties, Cancer Resource Center of the Finger Lakes, and the Cancer Services Program of Cayuga Medical Center Cortland and Tompkins Counties, strengthen cancer services provided by Cayuga Medical Center. and dermatologist American Cancer Society (ACS) Robert Morris offer In partnership with Cayuga Medical Center’s cancer program, Cancer Resource Room provides diagnosis-specific information, referrals to community and The Cancer Resource Room is located at Cayuga Medical free skin cancer screening ACS resources, and critical peer and professional support to all Center on the first floor of the adjacent medical office build- and prevention program those facing a cancer diagnosis. ACS provides resources for ing. The resource room is operated by Cayuga Medical Center transportation and lodging as well as a number of educational through an affiliation with the Cancer Resource Center of the in Cortland County and supportive programs for people living with a cancer diagnosis Finger Lakes, which serves as the lead agency for this service. and their families. (cancer.org) The room is open daily to provide support, information, and respite to people with cancer and their loved ones. Each year the Cayuga Medical 80% in Every Community Campaign of the Center’s Cancer Committee American Cancer Society Hospice and Palliative Care Services (HPCS) Targets an 80 percent colorectal cancer-screening rate. While Provides hospice services for people of any age with a terminal organizes and offers prevention Screening A free skin cancer colorectal cancer incidence rates have dropped 30 percent diagnosis, who are no longer receiving curative treatment. and screening programs targeted The goal of the screening program was to prevention and in the U.S. over the past decade, it remains the second leading Our goal is to help people live their final months as fully and screening program decrease the number of patients with late- cause of cancer deaths. Community. Approximately 30 percent peacefully as possible, by providing emotional and spiritual to meet the needs of the community. offered by the stage disease. Thirty-six participants received a of people between the ages of 50 and 75 are still not getting support, medical case management, and collaboration with Cayuga Medical Because of the success of a free free skin screening assessment from Dr. Morris. appropriately screened. In an organized effort to change these Center’s Cancer patients’ primary care providers. HPCS’s palliative care service skin screening held in Tompkins Each participant received a screening report Committee and numbers we are reaching out to local physicians to encourage PATH (Palliative Approach to Health) specializes in decreasing and educational materials on the prevention dermatologist screening referrals, and our nurse navigators are meeting the burden of illness and educating and supporting those County in 2017 and an increase in and early detection of skin cancer. Robert Morris, MD, with physician office staff members to help facilitate increased with life limiting disease. PATH provides advocacy and education melanoma over the past two years, reached more than appropriate screening. (cancer.org) to clients and 24/7 RN availability for support. Palliative physi- Screening follow-up process 100 people in cian consultations are also available for specific medical needs. the Cancer Committee felt it would for positive findings April 2018. Cancer Resource Center of the Finger Lakes (CRCFL) HPCS’s bereavement program provides grief counseling and be beneficial to provide this free Patients received their skin screening results Offers personalized support and information to area residents support groups to those who are grieving a loss. Our bereave- skin screening program in from the dermatologist following their exam- affected by cancer. Services include one-to-one assistance, ment program offers services to those who have experienced ination. The Cayuga Cancer Center Oncology facilitation of transportation on the Cornell Campus to Campus a loss while on hospice services, and community members Cortland County. Nurse Navigator contacted nine (25%) of the Bus, many support groups including the Women’s Noon Group, without connection to Hospicare. participants with positive findings and offered Men’s Breakfast Club, Young Adult Group, Cornell Support High quality healthcare is important at every stage of life, Prevention and Screening Event navigation support and services. Group, Living with Cancer as a Chronic Disease, Colorectal and we consider it a privilege to walk alongside those who Using evidence-based guidelines from the National Group, Cancer Research Group, Tompkins Prostate Support are facing life limiting or terminal illness, coping with grief, Cancer Network, the American Cancer Society, and Group, and the Cancer Education Series. CRCFL also offers a or seeking to learn more about these profound experiences. the American Academy of Dermatology, the Cayuga Results of the screening program evaluation well-stocked lending library; a boutique with free wigs, hats, (hospicare.org)

Cancer Center coordinated a community skin cancer and other items; wellness programs such as yoga and water • 95% of the participants reported that the prevention and screening program with Robert Morris, aerobics; resource guides; numerous volunteers who provide Cancer Services Program of Cortland and screening met their expectations MD, a Cortland area dermatologist. The program was assistance to cancer patients and their families at the Cancer Tompkins Counties • 95% of participants reported that they would held in April 2018 at the Cortland Business Showcase. Resource Center and at Cayuga Medical Center; and an Helps those with little or no health insurance gain access attend this event again experienced, caring local staff. The Cancer Resource Center to services to reduce the risk of breast, cervical, prostate, Prevention • 83% of participants reported that they learned also collaborates with Cayuga Medical Center on educational and colorectal cancers. For more information please call helpful information The goal of the prevention program was to reduce outreach programs such as the Living Well with Cancer series, (607) 758-5523. the incidence of melanoma. Displays, models, and • 65% of participants reported the program and colorectal awareness programs. (crcfl.net) convinced them to make changes in their educational materials raised awareness and educated health behaviors the community about the importance of screening, prevention, and the early detection of melanoma. • 38% of participants were male; 62% female A dermatologist, oncology nurses, oncology nurse • Ages ranged from 60 to 69 years navigators, and support staff connected with over 100 • Patients were extremely pleased with the participants. This program was well received and was a services they received great opportunity to reach Cortland County residents.

6 CAYUGA MEDICAL CENTER 2018 CANCER ANNUAL REPORT 7 New radiation unit planned for Cayuga Medical Center

C ancer patients receiving radiation damage to surrounding therapy will find faster and more healthy tissue. Both comfortable treatment options when accelerators use motion a new linear accelerator comes on management technology line in the fall of 2019 at Cayuga that synchronizes the Medical Center’s Radiation Oncology radiation beams with a Department. patient’s breathing and The new technology will replace body motion to target Cayuga Medical Center’s existing tumors with an exactness linear accelerator with equipment that measured in millimeters. improves and modernizes radiation Precise delivery of therapy. The TrueBeam® radiother- the radiation beam to apy system made by Varian Medical a patient’s tumor at Systems is an advanced medical linear the correct dosage is accelerator that is fully integrated for image-guided radiotherapy and essential in radiotherapy and requires a time-intensive process radiosurgery. The TrueBeam® unit treats cancer anywhere in the body to achieve that pinpoint accuracy. The new TrueBeam® imaging where radiation treatment is indicated, including lung, breast, prostate, technology produces the high-resolution images used to fine- head, and neck. The system delivers precise dose rates and can reduce tune tumor targeting in less time than previous Varian imaging treatment time for Cayuga technology. Shorter treatment sessions enhance patient John Powell, MD Cancer Center patients comfort and improve scheduling. receiving radiation therapy. “Cayuga Medical Center and Roswell Park have collaborated “The shorter duration for a to make state-of-the-art radiation therapy available locally treatment session allows for for patients since 2003. In planning for this new linear a more comfortable patient accelerator, we consulted with Roswell, which has experience experience with less time on with similar Varian TrueBeam® accelerators. We will be able to the treatment table. Precise share our experience and knowledge on the best ways to use adjustments to the table’s this equipment to care for patients,” says Dr. Powell. position can be made remotely, Collaboration is essential when commissioning a new improving set up and delivery accelerator. Sanjay Raina, PhD, is the Roswell Park medical of radiation therapy with the physicist at Cayuga Medical Center and will oversee the quality TrueBeam® technology,” says assurance, safety, and technical performance of the new John Powell, MD, of the Radiation Oncology Department at the Cayuga TrueBeam® unit so it operates at its full potential. The new Cancer Center and a member of the medical staff at Roswell Park TrueBeam® machine will be installed adjacent to the vault room Comprehensive Cancer Center in Buffalo. that contains the existing accelerator. When that radiation unit The new linear accelerator and Cayuga Cancer Center’s existing was installed in 2005, the building’s design included a plan unit both use high-energy beams to deliver prescribed doses of that anticipated its eventual replacement. The foundation for radiation to a target area. The beams are sculpted to match the the new accelerator is already in place so the new unit can be three-dimensional shape of a tumor or treatment region to minimize installed with minimal interruption of patient care.

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