A diagnosis of cancer—known by many as the “Big C”—can be a life-changing experience for patients and those who love them.
Feelings of fear, uncertainty, alienation and sometimes even guilt can be overwhelming. Complicating this reality is the need to understand the complexity of cancers and their treatments at a time when mental focus can be hard to muster.
Fortunately, even though the number of cancer cases diagnosed each year continues to rise worldwide, our knowledge of the wide range of cancers and their subtypes is rapidly increasing while the number of new drugs and treatments also grows. The introduction of new technologies and surgical procedures is also accelerating. In unison, these surges are rapidly changing how patients are treated, and precision medicine—treatments tailored for a patient’s specific class of cancer—is coming of age.
The Hunt Cancer Institute at Torrance Memorial Medical Center is playing a major role in the evolution of cancer care, investing in the latest technologies, networking a wide range of skilled cancer care specialists and expanding access to leading clinical trials. The result? Local patients are placed at the center of a comprehensive cancer care program providing a level of care that rivals national treatment centers.
Improved outcomes are palpable. What’s more, being treated locally—close to home and to support systems— reduces stress during patients’ journey with cancer, from diagnosis through treatment and survivorship.
ONE PATIENT’S STORY
Sheila Goldberg, 74, a self-taught artist and Redondo Beach resident, was given reason for concern when her primary care physician, Cynthia Williams, MD, told her there was an area of concern on her chest X-ray. Having been raised with the secondhand smoke of her parents and being an artist working with ceramics and other possibly carcinogenic mediums, Goldberg heeded her doctor’s advice that she have regular follow-up CT scans at six-month intervals.
Less than two years later, Goldberg’s doctors, guided by a collective recommendation from the Lung Tumor Board at the Hunt Cancer Institute, recommended she undergo surgery to remove a mass that was growing. According to Goldberg’s thoracic surgeon, Clark Fuller, MD, on staff at Torrance Memorial Medical Center, lung cancer can be twice as lethal as breast cancer and is more common in women than men. The majority of non-smokers diagnosed are women, who are more susceptible to secondhand smoke.
Following Goldberg’s surgery, pathology studies on the tumor confirmed a diagnosis of lung cancer. “Unlike many other patients, I didn’t hear the word ‘cancer’ until after my surgery,” she says. “But I was scared by the prospect of surgery. I was afraid of the large incisions lung surgery can require, and I react badly to painkillers. Fortunately, I was referred to Dr. Fuller. I was told that he and his colleague were using a new robotic system for the operation.”
The Food and Drug Administration first approved that robotic system, known as the da Vinci Surgical System®, in 2000 to facilitate complex surgery using a minimally invasive approach. Controlled by a surgeon from a console that provides a 3-D visualization of the surgical area, the system was first used commonly for prostate removal, gynecological procedures and increasingly for cardiac valve repairs.
Patient benefits provided by the system include small incisions, significantly less blood loss, reduced chance of subsequent infections and dramatically shortened recovery times. For these reasons, Torrance Memorial invested in the da Vinci system for an increasing number of surgical procedures, including lung surgery, in 2007.
After conducting their own research on robotic surgery, Goldberg and her husband, Louis, concluded it was the right procedure for her. “In the old days, patients needing lung surgery could be in the hospital for a week,” says Goldberg. “My surgery was on a Thursday. By Friday morning I was up, dressed and ready for discharge by the time Dr. Fuller came to check on me during his morning rounds. Even more amazing, Tylenol was the only pain medication I needed as I quickly went about my life. It was amazing.”
TUMOR BOARDS, A PIVOTAL RESOURCE
Discussing Goldberg’s diagnosis and treatment process, Dr. Fuller stresses the increasingly important role tumor boards play in enhancing patient treatment and outcomes. “While cancer treatment is a personal journey, when introduced to the concept of a tumor board, it is the first time patients realize that it is also a highly collaborative process. On that board you have all the specialists that may be involved in the treatment process. You have oncologists, radiation oncologists, pathologists, radiologists, nurses and, in the case of a lung board, thoracic surgeons.”
Dr. Fuller believes a comprehensive approach to developing a personalized treatment program gives patients a higher level of confidence and improves outcomes. “In a sense, it’s a forum for getting a second and third opinion. Physicians are a good database for knowledge, and we are programmed to share it. If we think there is a better way to treat a case, we will let each other know it.”
As there is no “one size fits all” treatment plan for cancer, a collective recommendation helps ensure patients receive the right level and optimal mix of treatment. “I learned early on that hearing the word ‘cancer’ can be a fearful moment in a person’s life, but what patients fear most is a lack of direction,” explains Dr. Fuller. “What they need is a sense of movement—they need to feel they and their medical team are actively doing something to counteract the cancer.”
He continues, “Torrance Memorial has done an excellent job in building its comprehensive cancer care program and integrating the latest non-invasive technologies. It has been embraced by the entire treatment team. There is an esprit de corps that helps get patients out and back to their lives. Some patients view requiring surgery as a failure. Nothing is further from the truth. But sitting in a hospital bed for a prolonged period of time and feeling sick isn’t good for healing physically and emotionally. The faster a patient can be discharged, the better their outlook, the faster their recovery. It’s empowering.”
Dr. Fuller underscores, “Robotic surgery is not a marketing device. It is a better mousetrap that eliminates six-month recovery periods, possible complications and provides better overall outcomes. In cases where adjuvant (post-primary) treatment such as radiation or chemotherapy is required, patients who have had minimally invasive surgery are able to better tolerate it.”
John Stoneburner, MD, Dr. Fuller’s colleague in thoracic surgery, agrees that a comprehensive approach to treatment, paired with the latest surgical procedures, has raised the level of cancer care for patients at the Hunt Cancer Institute. “Collaboration with our pulmonologists, oncologists, pathologists, radiation oncologists and radiologists is vital. It enables the thoracic surgeon to offer cutting-edge care.
In many cases, small cancerous growths in the lung can be detected and treated before the cancer progresses. “Navigational bronchoscopy (imaging and tissue sampling) enables small lesions to be biopsied earlier and minimally invasive thoracoscopic surgical techniques are then utilized to successfully resect (remove) these smaller lesions,” explains Dr. Stoneburner.
Oncologists, actively involved on tumor boards, are an important part of a patient’s cancer team, entering the treatment continuum at various points. Oncologists track a patient’s response to treatment and progress toward remission over time.
David Chan, MD,
Thomas Lowe, MD, of Cancer Care Associates—Torrance Memorial Physician Network, and
Wade Nishimoto, MD, at California Hematology Oncology Medical Group are oncologists affiliated with Torrance Memorial’s Hunt Cancer Institute. According to Dr. Lowe, cancer care has historically been delivered in a very fragmented fashion, with specialists all operating from their individual practices and perspectives. Often patients would be left to jump from specialist to specialist without a unified plan and networked health care team.
“While that approach may work well enough for some cancers, for cases like lung cancer a unified and highly coordinated approach is in the best interest of the patient,” explains Dr. Chan. “Every cancer and every patient is different. At our tumor boards, all the cancer specialists are able to review the data, discuss the latest standard of care options and come up with an optimized and personalized treatment plan, based on shared knowledge and experience.”
Discussing Torrance Memorial’s Hunt Cancer Institute and its comprehensive care model, Dr. Nishimoto makes several observations: “The program is constantly evolving and getting better, and that’s great news for the patients we serve. As oncologists, we are fortunate that Torrance Memorial has invested so heavily in building this program. Not all hospitals have the resources or even the interest to do so. It makes it easier to provide patients with the best standard of care possible.”
Dr. Chan also points out that the program is supported by a Cancer Resource Center with expert oncology nurse patient navigators who can guide patients through the treatment labyrinth, providing support and clarity throughout the process and on into survivorship. Dr. Nishimoto adds, “These types of programs are unique and are the way of the future. Cancer care in the South Bay has come of age.”
Dr. Lowe and Dr. Chan agree that the science of cancer treatment is rapidly progressing and while some cancers may not be able to be cured, they can now be managed like a chronic disease—a huge step forward for many cancer patients. Nationwide, the mortality rate for all cancers is dropping, says Dr. Chan.
Susan Condie, RN, a clinical nurse specialist with the program, provides a nursing perspective on the comprehensive approach to treatment: “The needs of cancer patients and their families are complex; for this reason, effective cancer treatment is difficult without a collaborative, interdisciplinary model of care delivery. Working together as partners is an essential characteristic of services within cancer care.”
According to Condie, staff commitment to combat cancer recently extended beyond the workplace. Some Torrance Memorial Medical Center oncology nurses and their friends formed a team to participate in the Revlon Run/Walk held in May. Their efforts raised funds to support breast cancer research.
CRUCIAL ACCESS TO CLINICAL TRIALS
Clinical trials are key to bringing new therapeutics to patients and extending lives. The clinical cancer teams at Torrance Memorial’s Hunt Cancer Institute are highly networked with the nation’s leading clinical trials centers and can easily navigate patients to appropriate trials.
“A lot of patients think being in a clinical trial means you are a guinea pig, which isn’t true,” explains Dr. Lowe. “Many believe incorrectly that trials are placebo-based and they are going to get treatment or not receive it. That’s only true for diseases where there is no existing treatment available. In approximately 95% of our trials, you are going to either receive the investigational drug and/or the current standard of care drug. I believe our oncologists and cancer navigators are doing a good job of advocating for our patients in trials and explaining to our patients how they work.”
KEY COMPONENTS—IMAGING AND PATHOLOGY
Key to diagnosing and treating cancers is imaging and pathology. Various imaging techniques are used to detect cancer and its possible progression in patients, including standard X-rays, ultrasound, computed tomography (CT), magnetic resonance imaging and even nuclear imaging, which often is used to determine if cancer has spread to bones.
In Goldberg’s case, a preemptive X-ray requested by her primary care physician revealed the suspicious area on her lung that was subsequently followed using CT scans every six months. The Hunt Cancer Institute at Torrance Memorial maintains state-of-the-art imaging facilities for its patients.
Patricia Sacks, MD, is the director of Torrance Memorial’s widely acclaimed
Breast Diagnostic Center, which diagnoses and treats more than 400 cases each year—the first dedicated breast cancer center in the South Bay, launched in 1992. According to Dr. Sacks, “It was clear to the visionaries—physicians and administrators at Torrance Memorial Medical Center—that women needed and wanted a facility that would address their special needs.”
The center’s unique focus of the needs of a specific cancer type provided much of the blueprint for the Hunt Cancer Institute’s expanded program. “At the Breast Diagnostic Center, we have been fortunate to continue to provide a program that carries women from sophisticated image investigation for screening through biopsy and referral for additional treatment if necessary,” explains Dr. Sacks. “Oncologists provide free consultation two days after biopsy to meet with patients and loved ones, explaining the pathologist’s diagnosis, and surgeons see these patients within a few days of diagnosis. The breast tumor board meets weekly with all involved specialists, providing an opinion as to the best treatment of each breast cancer case. Through all of this, highly trained and certified nurse navigators meet with, follow and check closely on our patients. They are such an important part of the glue that holds it all together. I believe the patients feel cared for by our experienced staff and empowered by what they learn. This turned out to be a great model for other types of cancers at the Hunt Cancer Institute.”
Depending on a patient’s case, pathology studies are often performed on tumors prior to primary treatment using tissue samples obtained through needle biopsies, with more in-depth assessments made once the tumor is removed. In Goldberg’s case, pathology studies were conducted post-surgery, confirming a cancer diagnosis.
The data obtained from pathology studies identifies the specific type of cancer (for example, small cell or large cell) and guides pathologists in characterizing and staging a patient’s disease. This data is invaluable in guiding the recommendations of the various tumor boards and treatment specialists.
According to Greg Baetge, MD, a leading pathologist on the Torrance Memorial Hunt Cancer Institute care team, “Pathological analysis of tumors is a key foundation to any cancer center. All tumors are diagnosed in the Torrance Pathology Laboratory using the latest surgical pathology techniques and tumor markers. Accuracy of the initial tumor diagnosis is of paramount importance in laying the groundwork for the appropriate patient treatment.”
Pathologists at The Hunt Cancer Institute use a battery of immunohistochemical stains. These exploit the presence of specific antibodies and antigens that are unique to each type of cancer to define the tumor subtype. All newly diagnosed tumors are reviewed by multiple pathologists to ensure the accuracy of the diagnosis. Tumor prognostic (projected outcome) markers are also obtained in the laboratory to allow the patient’s oncologist to optimize treatment for the patient.
Finally, when tumors are removed, the pathology team carefully analyzes the specimen to ensure the margins of resection (removal) are clear of tumor cells. They also assess for possible metastases to lymph nodes that would indicate advanced, non-localized disease.
“The pathologists at Torrance Memorial Cancer Center have been trained at some of the finest academic centers, including Stanford, UCSF and UCLA, and have many years of experience in tumor diagnostics,” concludes Dr. Baetge.
PATIENT SUPPORT FROM START TO FINISH
A unique component of Torrance Memorial’s cancer program is the Cancer Resource Center located on the medical center’s main campus. The center has medical navigation specialists to help patients understand their disease and guide them through the treatment process. It also provides a survivorship program designed to help patients transition from treatment to living healthy, cancer-preventive lives.
“Patients seek us out to gain clarity on their diagnoses and treatment options,” explains Paula Bauer, RN, an oncology nurse practitioner at the center. “We reach out to many admitted inpatient. The center definitely fills a need in the community.”
Bauer points out that the center has a wide reach within the South Bay community and that not all who contact the center are patients.
They may want information about risk factors, or they may have family histories of cancer. The center reaches out multiple times throughout the year making nearly 4,000 contacts some times contacting one patient numerous times.
“The patients in our community are extremely well cared for by their primary care physicians, specialists, oncologists, surgeons and nursing staffs,” explains Bauer. They have multiple options to have their questions answered and we are highly networked with their medical teams.”
Bauer underscores that the program is continually assessed to add new services and information resources for specific cancers. She explains that they are developing information-sharing processes for such instances where a patient may have a cardiac scan but there is an incidental finding in the lung, or to ensure that incidental data gleaned in the ER is shared automatically with a patient’s primary care doctor or specialists.
Following treatment, patients often experience feelings of uncertainty—not knowing “what’s next.” It can be a nerve-racking time as many patients worry if they have had enough treatment or if their cancer will recur.
“The Survivorship Program provides patients with information and resources to help patients live quality lives in what we are defining as ‘the new normal,’” explains Miriam Sleven, RN, who heads up the program. “Many patients don’t finish treatment and go back easily to being who they were prior to being diagnosed.”
The Survivorship Program provides a wide range of support services including access to local support groups, information materials and seminars that include cooking demos for healthy, cancer-preventive eating and healthy shopping outings to local markets.
A HEALTHY OUTLOOK, A QUALITY FUTURE
Just weeks after the removal of the cancerous tumor from her lung, Goldberg was back to a busy life with her husband, three children and six grandchildren. She continues to produce her stunning array of art.
“I no longer have cancer,” says Goldberg. “My wonderful team of health care specialists at Torrance Memorial were very well orchestrated, and I believe I received the best care I could get anywhere in Southern California.”
Her surgeon, Dr. Fuller, is currently providing ongoing post-treatment follow-up exams. When asked if she would return to the center if her cancer recurs, she gives a resounding “yes.”
“They were there for me in the past, and I know they’ll be there for me in the future if I should need them. If they were here right now, I’d give them a big hug of gratitude.”