May 24, 2017 – Englewood Hospital and Medical Center has expanded the services of its MDPartners physician office in Fair Lawn to include specialists in oncology, neurosurgery, vascular surgery, orthopedics and other services. With this expansion, residents of Fair Lawn and the surrounding area now have greater access to the nationally ranked services and providers from Englewood Hospital and Medical Center in their own community.
“Bringing this level of care into a community setting is just one way we are improving access to specialty services for patients,” said Michael Pietrowicz, senior vice president and chief strategy officer, Englewood Hospital and Medical Center. “When faced with difficult medical decisions, it is comforting to know that you have world-class care that you can trust, right in your own backyard.”
Most major insurance plans will be accepted. To learn more, confirm insurance or schedule an appointment, call 973-321-2755.
Location: 22-18 Broadway, Suite 301 Fair Lawn, NJ 07410
New Physicians at this location:
Marc Arginteanu, MD, Chief of Neurosurgery, Englewood Hospital and Medical Center
Thomas Bernik, MD, Chief of Vascular Surgery, Englewood Hospital and Medical Center
Steven Brower, MD, FACS, Medical Director of The Lefcourt Family Cancer Treatment and Wellness Center; Chief of Surgical Oncology and Hepatobiliary Surgery, Englewood Hospital and Medical Center
Minaxi Jhawer, MD, Chief of Hematology and Oncology, Englewood Hospital and Medical Center
Michael Magrino, DO, General Surgery, Englewood Hospital and Medical Center
Venkata Marella, MD, Urology, Englewood Hospital and Medical Center
Jill Morrison, MD, Hematologist/Oncologist, Englewood Hospital and Medical Center
Anna Serur, MD, Chief of Colon and Rectal Surgery, Englewood Hospital and Medical Center
Asit Shah, MD, Chief of Orthopedics, Englewood Hospital and Medical Center
Kevin Yao, MD, Neurosurgery, Englewood Hospital and Medical Center
Stephen is no stranger to aches and pain. As a volunteer fireman, surfer, and kiteboarder he can take a lot, but when he woke one morning with excruciating back pain, he knew something was wrong. Unable to sleep and enjoy his favorite activities, Stephen turned to Dr. Kevin Yao, a neurosurgeon at Englewood Hospital and Medical Center, who determined that two nerves in Stephen’s spinal cord were severely damaged and there was a small window of opportunity to repair them. Crediting the personal connection he felt and Dr. Yao’s expertise, Stephen decided to take the plunge and undergo minimally invasive spine surgery.
The five basic principles of yoga are exercise, breathing, relaxation, diet, and meditation. Being a yoga instructor herself, Mary Ann Fernandez was probably as mentally and physically resilient to face cancer as can be hoped. That didn’t make it any easier, however, when she was diagnosed with breast cancer in August of 2015.
“I remember when they said the words, ‘breast cancer,’ it all became fuzzy. I just collapsed because I didn’t anticipate this being a big deal — I even had my youngest son in the waiting room. I had to walk out and look at him,” Fernandez says.
A mother of three and the owner of a brand-new yoga studio, Fernandez was in great health at the time of her diagnosis, so the news came as that much more of a surprise to her and her family.
“Everything moved really quickly after that. I met my surgeon, Dr. [V. Merle] McIntosh, had more MRIs and testing done and began chemotherapy with my oncologist Dr. [Jill] Morrison,” Fernandez says.
She was initially hesitant to undergo treatment, wondering if there was a holistic alternative she could explore rather than surgery and chemotherapy. “Ultimately, I was like, ‘I have three kids. I have to do treatment. I have to stick around,’” she says.
Fernandez’ relentless optimism is what carried her through cancer treatment. At no point did she consider the possibility that she would not be OK in the end. She never lost her positive spirit or her sense of fun.
“I had a little project going on. I decided each day at chemotherapy was a theme, dressed up and took pictures. One day was The Matrix — I dressed up and had the blue cupcake and the red cupcake. Another was IV pole dancing — I came in a bikini and fur boots. If I had to be there for three hours, I was going to have fun,” Fernandez says.
“Mary Ann was always so upbeat and positive about getting through her treatments and beating this,” says Dr. McIntosh. “She was an inspiration and continues to be, as she works hard to motivate others to take care of themselves and to have an optimistic outlook.”
Today, Fernandez is cancer free and back to doing what she loves. She teaches yoga, not only in her studio, but also at the Graf Center for Integrative Medicine at Englewood Health. She donates her time to Graf Center; she felt it was important to give back to the place that helped her through this incredibly tough time.
“I was in the best hands I can imagine at Englewood Health. I’m so happy I choose to go there.”
The behavioral health team at Englewood Hospital and Medical Center recently received the Horizon National Chiasson-Schmitt Partnership Award from Horizon Health, a national leader in behavioral health services. Dating back to 2003, the partnership between Englewood Hospital and Horizon Health has helped to ensure that patients receive high-quality and save behavioral health services in a compassionate environment. Pictured, the Englewood Hospital and Medical Center and Horizon Health administrative teams, along with the behavioral health team from Englewood Hospital.
Dr. Anna Serur, chief of colon and rectal cancer and Dr. Minaxi Jhawer, chief of hematology/medical oncology
For decades, colorectal cancer has predominately affected older adults, but according to a new study published in the Journal of the National Cancer Institute, colorectal cancer is on the rise in adults younger than 55, with a particularly sharp increase in those in their 20s, 30s, and 40s. Researchers at the American Cancer Society and National Cancer Institute noted that those born in 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with someone born around 1950.
Often called a silent disease because of its lack of initial symptoms, colorectal cancer will be diagnosed in more than 95,000 people this year, according to the American Cancer Society. It is the third most common cancer diagnosed in both men and women in the United States. In recognition of Colorectal Cancer Awareness Month, Dr. Anna Serur, chief of colon and rectal surgery at Englewood Hospital and Medical Center and Dr. Minaxi Jhawer, chief of hematology/medical oncology at Englewood Hospital and Medical Center, who specializes in gastrointestinal cancers, shed light on the complexities of this cancer.
Q: What are the suspected causes of colorectal cancer?
Dr. Jhawer: Research has linked colorectal cancer to family history and particular inherited conditions as well as a variety of environmental and lifestyle factors, including physical inactivity, certain types of diets such as western diets, which are high in processed foods and meats, obesity, heavy alcohol use, and smoking. There’s also evidence that conditions such as inflammatory bowel disease – Crohn’s disease and ulcerative colitis – may contribute to a higher risk of colon or rectal cancer.
Q: What are some reasons why we’re seeing higher colorectal cancer rates in young people?
Dr. Serur: The only leads we have are that an increase in these rates in young people parallel the increase in rates of obesity and diabetes, which are often correlated with dietary patterns and sedentary lifestyles. As a society, we’re not as active as we used to be and today’s diets often include high saturated fat, high-glycemic carbohydrates, carbonated drinks and processed foods.
Q: What are a few ways people can reduce their risk?
Dr. Jhawer: Adopting a healthy lifestyle is always a great recommendation. Some general guidelines include:
Get plenty of physical activity
Maintain a normal weight
Actively manage stress
Avoid tobacco products
Limit consumption of processed foods and red meat
Eat a diet of varied and whole grains, lean proteins, and colorful fresh fruits and vegetables daily
I also encourage people to not just take steps to prevent illness but to engage in activities that promote relaxation, stress reduction, and overall wellness. Our Graf Center for Integrative Medicine, for example, offers medically supervised therapies including yoga, massage, nutritional counseling, guided meditation, and stress management. Screening colonoscopies, starting at age 45 for those with average risk, may help detect precancerous polyps – growths on the lining of the colon and rectum – that can then be removed. Those with a family history and/or predisposition for colorectal cancer may be eligible for genetic counseling to assess risk and be considered for earlier screening tests.
Q: What are some symptoms that may be missed as signs of colorectal cancer?
Dr. Serur: In its early stages, colorectal cancer may not have any symptoms. But as colorectal cancer progresses, people may experience rectal bleeding, a change in bowel habits, abdominal pain, blood in the stool, and unintended weight loss. Those are patients that shouldn’t ignore their symptoms. I always tell my patients, “Listen to your body, if something feels wrong, get checked out.”
Q: What should people know about the rates of colorectal cancer?
Dr. Serur: The rates of colorectal cancer are declining in older people. Young people still represent a small number of those diagnosed with colorectal cancer, but a majority of this population is diagnosed at a later stage, which impacts prognosis and survival. We may be missing these younger people because they are not routinely screened and there may be a belief that the symptoms are something minor like hemorrhoids instead of a more serious illness. Our recommendation as GI and colorectal surgeons is to have practitioners appropriately send patients to us or to a gastroenterologist to make sure they don’t have colorectal cancer. In order for us to identify young people at risk, though, we need to raise awareness and educate about this disease.
Q: Is colorectal cancer treatable?
Dr. Serur: In general, patients with early colorectal cancer have excellent prognosis if treated appropriately by an experienced team. Whether early or advanced stage, treatment has advanced significantly; it’s no longer a one-size-fits-all approach. At Englewood Hospital, we use a team approach, with input from other surgeons, oncologists, radiologists, radiation oncologists, nutritionists, pathologists, nurses and nurse practitioners, integrative medicine experts, and social workers to provide a tailored and personalized plan of care. Using state-of-the-art technology, we can offer treatments that are oncologically sound, tailored to a particular individual and lead to great outcomes. In my specialty, I use minimally invasive techniques using robotic and laparoscopic surgery, which allow patients to return to pre-surgery functions quicker, results in a more acceptable cosmetic appearance, and leads to better patient satisfaction without compromising cancer-free prognosis.
Q: What emerging treatment areas are available for people diagnosed with colorectal cancer?
Dr. Jhawer: Over the past few decades, there has been tremendous evolution in treating patients with colorectal cancer. In the earlier stages the cancer is treated with surgery followed by chemotherapy. As cancer progresses, not all patients benefit from chemotherapy. We are able to use precise molecular testing on the tumor sample to assess which patients would benefit from chemotherapy and for whom we can limit the use of the drugs and limit toxicity as they have a better prognosis.
In advanced stages, surgery might still be an option if the disease is localized to a single area. But for the most part in advance stages, chemotherapy, biologic therapy and immunotherapies are used. We are able to send off a full molecular panel of their tumor sample to target and use agents which might work best for their tumor type i.e., personalizing the medicine.
Englewood Hospital hosted its second annual cancer symposium to review the latest screenings and treatments for lung and GI cancers in Asian populations.
Physicians and other health care professionals gathered at an education seminar at Englewood Hospital and Medical Center to discuss the prevalence of lung and gastrointestinal cancers in Asian populations and some of the medical center’s personalized treatments.
The Lefcourt Family Cancer Treatment and Wellness Center at Englewood Hospital hosted its second annual cancer symposium to review the latest screenings and treatments for lung and GI cancers in high-risk populations, particularly in the Asian and Asian American populations, who are at greater risk for developing certain cancers, such as liver and stomach cancer.
“We’re honored to take care of specialized populations in this cancer center, and we want to bring to the forefront screening identification, prevention and treatment for patients who are living with or surviving these types of cancers,” said Steven Brower, MD, medical director of the cancer center and chief of surgical oncology and hepatobiliary surgery at Englewood Hospital.
Dr. Brower spoke about identifying GI cancers early and determining the differences between Asian Americans and those from other ethnicities who develop the malignancy.
According to the National Cancer Institute, liver and stomach cancer incidence and mortality are highest among Asian Americans compared with all other ethnic groups. A 2016 report from the American Cancer Society estimates there will be 57,740 new cancer cases and 16,910 cancer deaths among Asian Americans, Native Hawaiians and Pacific Islanders annually. There is a need for improved use of vaccinations and screenings, interventions to control weight, alcohol and tobacco use, and more research on the differences in cancer burdens in this population.
“Here in Bergen County, we have a very high population of Asians, especially Koreans, and recognizing a need to understand the specific risks that this patient population has and how to best treat them is the focus of our talks,” said Brian Kim, MD, a hematology/oncology specialist at Englewood Hospital, and the moderator of the symposium.
Advances in Lung Cancer Screening
Englewood Hospital’s radiology department is currently working with primary care physicians, internists and family practitioners to identify patients at risk for lung cancer and initiate screening earlier.
Mark Shapiro, MD, chief of radiology at Englewood Hospital, spoke at the cancer symposium about the role of low-dose CT scans for screening patients for lung cancer. He said patients must meet the criteria for screening guidelines (age range, 55-77 years with a strong smoking history) in order to undergo CT.
“CT has been proven in various studies to decrease the mortality from lung cancer. It’s critical that when clinicians see patients that fall into the guidelines for the screening that they undergo this low-dose screening CT scan,” Dr. Shapiro said.
Lyall Gorenstein, MD, a thoracic surgeon at Englewood Hospital, presented ways to use thoracic surgery and minimally invasive techniques to diagnose and manage solitary pulmonary nodules and avoid unnecessary lung biopsies.
“That’s a key goal of any multidisciplinary team, to really expedite the care rather than have patients being shuffled between one doctor and another, so time goes on and their anxiety about their cancer builds,” Dr. Gorenstein said. “Being able to offer one-stop shopping in a very beautiful environment – that’s something I think makes Englewood a little unique compared to our regional competitors.”
The oncology team at Englewood Hospital is committed to working with other departments and outside health care providers to treat high-risk populations who have cancer, and offer screening and preventive services to patients as soon as they are identified to be at risk.
“Our physicians in the cancer center are at the forefront of identification of high-risk patients, and those of us who actually treat the patients hope to get these patients early,” Dr. Brower said.
Acupuncture. Aromatherapy. Reiki. What do all of these have in common? For one, these treatments were once disregarded as medical therapies. For another, one might not expect to find them being practiced in an oncology suite. But as evidence of the effectiveness of these treatments mounts, more progressive and multidisciplinary oncology departments are implementing them in their practices and calling the result “integrative medicine.”
Despina Psillides, MD, Medical Director, Graf Center
Patients have shown interest in integrative medicine for a long time, said Despina Psillides, MD, medical director of the Graf Center for Integrative Medicine at Englewood Hospital and Medical Center. What is new is the acceptance of these alternative treatment modalities by mainstream medicine.
“In the past, even in the beginning of my training, there was a lot of resistance to integrative medicine,” Dr. Psillides said. “What started to happen was more and more studies came out showing efficacy, more and more patients started responding, and things started changing.”
At the Graf Center, Dr. Psillides and her colleagues take standard internal medicine approaches to treat oncology patients and supplement them with alternative modalities when appropriate.
“Say a patient with cancer is having a lot of side effects from their chemotherapy, and the oncologist has decided to stop treatment due to the side effects,” Dr. Psillides said. “If we can improve those side effects with an alternative modality, then the patient can go on and complete the treatment. We can really make a difference in that way.”
With cancer patients especially, integrative approaches can help with quality-of-life issues, Dr. Psillides said. When a patient receives treatment for their disease, integrative treatments such as acupuncture can help relieve their emotional stress. Dr. Psillides, who studied acupuncture at Harvard University, said it has been shown to effectively treat chemotherapy-related nausea, arthritis and dry mouth, a significant issue for patients with head and neck cancer.
In addition to acupuncture, the Graf Center also employs massage therapists, Reiki practitioners, yoga teachers, nutritionists and other specialists to provide what Dr. Psillides described as “a truly multidisciplinary form of care” when combined with the work of her colleagues at the cancer center. “It’s a testament to patient demand and the medical community’s openness to complementary modalities,” she said.
The availability of the integrative approach in a safe and monitored setting can also prevent cancer patients from seeking out alternative treatments on their own, which can involve trusting questionable sources of information or taking supplements that may interfere with their chemotherapy, Dr. Psillides said. “At the Graf Center, we can focus on the educational aspect—we can guide patients on what is safe or not safe. That kind of guidance isn’t always readily available.”
When they aren’t treating patients, Dr. Psillides and her colleagues are staying up-to-date on the latest research and finding ways to contribute to advancing the field. Currently, they are seeking approval to conduct a study examining the efficacy of aromatherapy in treating chemotherapy-induced nausea.
Dr. Psillides said her aim is to focus on the whole person when treating patients. “It’s not just about the underlying disease; it’s about the appropriate treatment, the appropriate diet, stress relief and overall quality of life,” she said. “That’s really our goal here, and the fact that we’re able to provide it is wonderful, and it’s new, and I believe it’s really the future of medicine.”
When the National Lung Screening Trial published its results, it got quite a bit of attention, and for good reason. It was the first prospective, randomized study to conclusively show that early detection of lung cancer saves lives.
Mark Shapiro, MD, Chief, Department of Radiology
“One of the controversies around cancer screening is that a test might find cancer, but it isn’t clear that there is any survival benefit associated with early detection,” said Mark Shapiro, MD, chief of the Department of Radiology at Englewood Hospital and Medical Center. “But in this study of more than 50,000 people randomized to either low-dose CT scan or standard chest x-ray, there was up to a 20% improved survival in those who underwent CT. That was huge.”
Many institutions soon began offering low-dose CT scans to high-risk patients at nominal cost. When Englewood Hospital established its lung cancer screening program, it went one step further and offered low-dose CT scans at no cost until Medicare began covering the modality in 2015. Other insurers followed suit. Englewood Hospital now offers low-dose CT scans to all patients who meet the criteria of being 55 to 80 years of age with a strong smoking history, as per the National Cancer Institute guidelines.
Lyall Gorenstein, MD, Thoracic Surgeon
“At this point, we’ve screened a little more than 500 patients, out of whom we’ve diagnosed six with lung cancer,” said Lyall Gorenstein, MD, a thoracic surgeon at Englewood Hospital. He noted that this number is consistent with the 1% to 2% diagnosis rate described in the literature. “Four patients had early-stage disease and two were more advanced, but they were diagnosed much earlier than they would have been if we had waited for symptoms,” Dr. Gorenstein said.
Multidisciplinary Care Under One Roof
Since its establishment two years ago, The Lefcourt Family Cancer Treatment and Wellness Center provides rapid and seamless diagnosis and treatment once a CT scan detects potential cancer in a patient. The center incorporates a multidisciplinary approach to the internal workings of the cancer program, and a new building was constructed to house everyone involved in lung cancer patient care under one roof.
“This has always been the correct way to manage lung cancer, but now we have all the subspecialists in geographic proximity,” Dr. Gorenstein said. “Once someone is seen by the medical oncologist, they come up to my office to see the surgeon; then we take them downstairs to see the radiation therapist. So it all happens very quickly.”
Every patient is evaluated in real time by a pulmonologist, a thoracic surgeon, a medical oncologist and a radiation oncologist. “Often, there would be a lengthy delay from the time that patients are told they have a shadow on their lung to the point where they actually get treated. We make every effort to expedite that process to spare patients as much anxiety as possible,” Dr. Gorenstein said.
Every month, all subspecialists on the thoracic cancer team attend a multidisciplinary conference to discuss each patient recently diagnosed with lung cancer. Pathology and radiology are reviewed, and treatment options are discussed from a multidisciplinary perspective. “We go over everything from A to Z: the initial diagnosis, the treatment, the management. We have everyone’s opinion, and we come up with a formal treatment plan,” Dr. Shapiro said.
Most patients with lung cancer who undergo surgery will have a minimally invasive procedure, which allows them to recover faster and experience far less surgical site pain. For patients with early-stage lung cancer who are not candidates for surgery, Englewood Hospital uses the TrueBeam Radiotherapy System (Varian Medical Systems), which delivers high-dose stereotactic radiation therapy and is capable of treating patients in only five sessions. “Ours is one of the few centers in the region to have that state-of-the-art piece of equipment,” Dr. Gorenstein said.
Physicians at Englewood Hospital also are active on the investigative side and participate in a variety of multi-institutional prospective studies. “There are a lot of exciting new things happening in lung cancer, such as targeted therapies based on cancer genetics and immunotherapies,” Dr. Gorenstein said. “Because our center is affiliated with several national oncology groups, our patients have access to many clinical trials. In fact, we currently have active trials for patients in every stage of lung cancer.”
Englewood Hospital uses the TrueBeam system, which delivers high-dose stereotactic radiation therapy and is capable of treating patients in one session.
Tumors in the brain no longer need to be treated with a maximum-level radiation dose, thanks to a new radiation therapy technique used by physicians at Englewood Hospital and Medical Center.
Surgeons and radiation oncologists at the medical center are working together to target tumors while sparing surrounding brain tissue from radiation exposure.
David Dubin, MD, Chief, Radiation Oncology
“This stereotactic radiosurgery [SRS] technique is very sophisticated, very precise and requires a lot of remarkable technology,” said David Dubin, MD, chief of radiation oncology at Englewood Hospital. “There are a lot of extra bells and whistles that lead to remarkable outcomes for our patients.”
Dr. Dubin performs SRS using a TrueBeam Radiotherapy System (Varian Medical Systems), which allows the patient to wear a thermoplastic mask. “The patient doesn’t need screws placed in their skull for rigid-fixation SRS, which is painful. With the TrueBeam linear accelerator, there’s a form-fitting mask that allows us to make adjustments for the patient and to maintain comfort,” Dr. Dubin said.
“We have six degrees of freedom in our range of motion, so we can produce a 3-D image of the tumor that accurately accounts for pitch, roll and yaw,” he explained.
The accurate 3-D image of the tumor enables physicians to target high-dose radiation solely to the tumor. “The technology is so advanced that we can isolate the tumor in space so it receives the full dose of radiation, and the exposure to the surrounding areas is negligible,” Dr. Dubin said. “The patient is often treated completely after just one dose, and experiences no nausea, no vomiting and no blurred vision, and can go home that day.”
In cases of anaplastic glioma, adjuvant therapy often accompanies radiation therapy. A recent study (J Clin Oncol 2016;34:abstr LBA2000) found that patients who received temozolomide (Temodar, Merck) after radiation therapy experienced slower disease progression and higher five-year survival rates. “We look at the research and consider it in our treatment plan, but anaplastic glioma is a very small percentage of brain cancers,” Dr. Dubin said. “The vast majority of patients we see only need localized radiation.”
Combined, Complementary Expertise
The success of localized radiation therapy and increased patient satisfaction is the result of a team effort from the physicians and staff at Englewood Hospital. “The treatment planning is the most important part,” Dr. Dubin said. “From the patient’s primary care physician to a physicist to a nurse navigator, everybody is involved in the treatment plan.”
Dr. Dubin works closely with Kevin Yao, MD, a neurosurgeon at Englewood Hospital. “Every step is done in multidisciplinary fashion,” Dr. Yao said. “We want to preserve meaningful functional longevity for the brain, so we combine our complementary expertise to formulate a plan together. Dr. Dubin’s expertise is in delivering radiation and determining what radiation dose the brain and body can tolerate. Mine is defining what is tumor versus what are normal brain structures.”
Dr. Yao champions SRS for certain brain conditions over traditional radiation therapy, which blankets the brain. “SRS treatment is done once on an outpatient basis; there’s minimal radiation to the normal brain; and it often can be repeated if the cancer returns,” Dr. Yao said. “With traditional whole-brain treatment, you can’t repeat this type of radiation even if the tumor survives or another returns.”
Drs. Dubin and Yao typically plan surgery with an on-staff physicist, who calibrates the linear accelerator so the radiation dose will only affect the tumor. “In radiosurgery, it is essential for us to define not only the boundaries of the tumor but also the surrounding brain anatomy, so the radiation dose will only affect the tumor in the brain. This process enables us to safely treat a tumor while preserving normal brain function.”
An especially important element of planning is fusing MRI and CT scans for an accurate picture. “Neuroradiology is involved in the process from pretreatment planning to follow-up evaluations to assessing tumor response,” said Marc Herman, MD, a neuroradiologist at Englewood Hospital. “The radiation treatment plans are dependent on accurate imaging assessment. Precise localization of the tumor to provide for the most effective treatment is a critical component of this process.
“The neuroradiologists at Englewood Hospital use advanced MRI applications, including spectroscopy and perfusion imaging, to more accurately assess tumors and treatment effects to help guide management.” Englewood Hospital also uses a 3-Tesla MRI scanner, which provides the highest-resolution MRI examination in clinical practices today, to thoroughly evaluate brain tumors.
These applications provide information at the molecular level, which routine MRI cannot. In addition, this technology allows for a more accurate distinction between tumor and treatment-related changes.
Regarding Englewood Hospital’s multidisciplinary team in the treatment of brain tumors, Dr. Herman said, “It’s great to be part of this team.”
The oncology team at Englewood Hospital and Medical Center works across disciplines to create the optimal personalized care plan for its patients. Part of that plan involves a comprehensive understanding of the patient as a whole and a detailed study of the patient’s tumor biology in order to treat it appropriately.
“We’ve really come a long way in being able to use drugs that specifically target certain aspects of the cancer pathway that not only improve our cancer outcomes but also make therapies more tolerable for the patient,” said Minaxi Jhawer, MD, chief of hematology/oncology at Englewood Hospital.
A recent study presented at the 2016 annual meeting of the American Society of Clinical Oncology found that in patients with advanced colorectal cancer who express HER2, targeting the HER2 receptor with biologic drugs could shrink the tumor by 30% or more (abstract LBA11511). “It’s a small percentage of colorectal patients (<5%) who have HER2 overexpression,” Dr. Jhawer said. “But it does show that precision medicine is very effective in treating advanced-stage tumors.”
If a patient has advanced or stage IV cancer, the medical center’s oncology team studies the pathology sample in detail to understand the biology of the tumor and to identify different targets for drug therapy. A look at the microsatellite DNA recognizes instability and errors, as well as deficiencies in mismatch repair in tumor DNA. “After we take in the biological and molecular information, we can determine which patients will benefit from specific immunotherapies,” she said.
When a patient presents with colorectal cancer, Dr. Jhawer’s medical oncology team springs into action. Patients with stage II or some with stage III cancer receive an Oncotype (Genomic Health) test to pinpoint the genes at play, determine the likelihood of recurrence postsurgery, and determine whether they will need chemotherapy and radiation therapy. “If the Oncotype score is low, it informs us that the odds of recurrence are low and these patients will not benefit from chemotherapy, and if the oncotype score is high, they will likely have a higher risk of recurrence and hence will benefit from the chemotherapy regimen. This helps make a very personalized plan for all our patients,” Dr. Jhawer said.
As a medical oncologist, Dr. Jhawer works closely with the surgeons to form a treatment plan for the patient. “There’s a multidisciplinary team of several exceptionally qualified physicians who orchestrate and form a comprehensive cancer care plan for the patient,” she said. “We don’t just treat the cancer but the patient as a whole, and strive to improve the quality of life for all our patients.”
In addition to a medical oncologist and surgeon, a pain and palliative care physician, a geneticist, a nutritionist, an integrative medicine physician and possibly a radiation oncologist also see the patient. “The patient’s internist continues to be an integral part of this planning and process, which means the doctor that probably has the closest relationship with the patient and the patient’s family is absolutely part of the care team,” Dr. Jhawer said.
To help with the overall care of the patient, Dr. Jhawer initiated and spearheaded a free yoga program for all patients diagnosed with cancer, which is buttressed by research that shows yoga helps cancer patients improve their sleep and mood, and it combats pain and fatigue.
The patients are also taught about the anticancer benefits of mushrooms, turmeric and aspirin and instructed to take vitamin D, since low levels of vitamin D correlate with a high risk of return for cancer. “This is very different from hospitals that will shuttle patients from building to building to go from a surgeon to radiation oncologist. Here, we’re bringing all the physicians together to the patient and are treating not just the cancer but the whole person using all possible avenues of care.
“We really practice many different levels of personalized medicine,” Dr. Jhawer said, “and it leads to improved outcomes.”
Posted March 2017
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