Cancer Symposium Focuses on Lung and GI Cancers in Asian Populations

Posted on by Grace Migliorisi
Englewood Hospital hosted its second annual cancer symposium to review the latest screenings and treatments for lung and GI cancers in Asian populations.
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.

Posted March 2017

Graf Center for Integrative Medicine: Expanding the Meaning of “Multidisciplinary”

Posted on by Grace Migliorisi

 

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
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.”

Posted March 2017

Screening, Treating and Researching Lung Cancer

Posted on by Grace Migliorisi

 

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
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
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.”

National Lung Screening Trial Study Findings

Posted March 2017

Stereotactic Radiosurgery Delivers Targeted Dose To Brain While Minimizing Toxicity

Posted on by Grace Migliorisi
Englewood Hospital uses the TrueBeam system, which delivers high-dose stereotactic radiation therapy and is capable of treating patients in one session.
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
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.”

Posted March 2017

Changing Paradigm for the Treatment of Colorectal Cancer

Posted on by Grace Migliorisi

Personalized Medicine With Molecular Profiling

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

Pros and Cons of Current Breast Cancer Screening Guidelines Reviewed

Posted on by Grace Migliorisi

 

Many women are told by their physicians to get screened for breast cancer; however, exactly when that screening should start has become a topic of disagreement.

Breast cancer screening at a glanceSeveral organizations have published guidelines for breast cancer screening in the past two years, including the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS). Both organizations have established screening guidelines written by internists and oncologists, but they differ slightly.

The USPSTF recommends women undergo biennial mammography starting at 40 to 50 years of age. The ACS, on the other hand, recommends women of average risk have screening exams from ages 40 to 44, and annual mammography from 45 to 54. From age 55 onward, women should undergo mammography every other year, although continuing annual screening is acceptable.

Although the traditional U.S. guidelines recommend annual screening beginning at age 40, countries such as the United Kingdom and Canada require screening later and less frequently. With that in mind, physicians at Englewood Hospital and Medical Center examined the issue to determine how early and how frequently breast cancer screening should take place.

Miguel Sanchez, MD, Medical Director, Chief of Pathology
Miguel Sanchez, MD, Medical Director, Chief of Pathology

“We looked at a comprehensive set of data over many years and found that if we followed less stringent guidelines, we would have missed 20% of all breast cancer cases,” said Miguel Sanchez, MD, chief of pathology at Englewood Hospital and medical director of the Leslie Simon Breast Care and Cytodiagnosis Center. “That’s a substantial number that would have slipped under the radar.”

The data are compelling for physicians at the breast center, which has over 55,000 patient visits per year. “We’re seeing that many patients, and we still don’t recommend loosening the screening guidelines,” Dr. Sanchez said. “It’s something we discuss in our weekly conference and really dissect how changes will affect our detection rate.”

Mindy Goldfischer, MD, Chief of Breast Imaging
Mindy Goldfischer, MD, Chief of Breast Imaging

The ACS’s current guidelines have received criticism for the high number of false-positive results that mammograms produce, as well as the detection of noninvasive stage 0 cancers that lead to aggressive treatments. “We are able to provide our patients with mammogram results while they wait. So if additional imaging is needed, it can be performed during the same visit. As a result, our patients do not have to be anxious about false-positive results,” said Mindy Goldfischer, MD, chief of breast imaging at Englewood Hospital.

“At present, we cannot tell which breast cancers will remain stage 0 and which will become invasive. In the near future, ongoing research will likely be able to provide individualized treatment recommendations based on a person’s specific tumor type,” Dr. Goldfischer said.

The physicians at Englewood Hospital rely on science, their expertise and a spirit of collaboration imbued in the center’s professional culture to determine the best care for their patients. “Guidelines are simply guidelines, but not necessarily what a physician must follow,” said Violet Merle McIntosh, MD, section chief of breast surgery at Englewood Hospital. “We look at the individual and ask, ‘Does the patient have reasons to be screened more closely? Is there something about the woman’s family history? Does her race or genetic history suggest we should screen earlier?'”

Dr. McIntosh believes women identified as high risk should have a baseline screening at age 35, a second screening around age 38 and an annual screening starting at age 40. “While low-risk women could wait until 40, the notion of waiting until 50 is not sensible,” she said. “Seventypercent or more of breast cancer cases we see are from women with no family history of breast cancer. So it really doesn’t make sense to wait to screen just because you don’t know of breast cancer in the last few generations. “And with the increasing use of 3-D mammograms, the false-positive rate has decreased,” Dr. McIntosh said. “Primary care physicians are encouraged to continue referring patients for screening.”

Physicians at Englewood Hospital meet every Wednesday with the oncologists, surgeons, geneticists, pathologists, radiologists and radiation oncologists to discuss every new patient case and to create an individual plan for each patient. The meeting is broadcast live to international hospitals trying to emulate Englewood’s program.

These weekly meetings address more than just how to treat a tumor. “We present the patient’s history, images and pathology,” Dr. Goldfischer said. “We address social issues such as, ‘How will an elderly woman living alone get to the hospital for daily radiation treatments?’ All aspects of the individual patient’s medical and social history are considered when we formulate a treatment plan.”

“Our weekly multidisciplinary conference is unique,” Dr. Sanchez said. “It is composed of physicians of every subspecialty related to the diagnosis and treatment of breast cancer, in addition to the patient navigator, nurse practitioner who specializes in genetics, nurse who runs clinical trials, social worker, residents and tumor registrar. And for the patient, you don’t get one second opinion—you may get many second opinions.”

Breast cancer screening recommendations

Posted March 2017

Technological Advances Enable Highly Complex Laparoscopic Sphincter-Sparing Surgery

Posted on by Grace Migliorisi
Englewood Hospital has a brand new operating room, where surgeons perform the most cutting edge operations, including sphincter-sparing surgery and transanal total mesorectal excision.
Englewood Hospital has a brand new operating room, where surgeons perform the most cutting edge operations, including sphincter-sparing surgery and transanal total mesorectal excision.

Thanks to technological advances, patients with colon cancer now can be presented with an alternative to life with a colostomy bag. Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons employ laparoscopic techniques that preserve the sphincter and maintain bowel continuity.

“Techniques like sphincter-sparing surgery have the same oncological results as an abdominoperineal resection, but they are technically challenging operations,” said Anna Serur, MD, chief of colon and rectal surgery at Englewood Hospital and Medical Center, who routinely performs the minimally invasive surgery.

Complicated surgeries that require experienced hands are regularly performed at Englewood Hospital. “We’ve assembled a team of regional experts to serve our community that equals the expertise of the leading cancer care centers in New York City,” said Michael T. Harris, MD, chief medical officer, and chief of surgery and surgical services, at Englewood Hospital. “We have the latest technology, the newest infusion center and the newest radiation oncology machines in facilities that are as good as any that you will find in New York. That technology makes our treatment more focused and with fewer side effects.”

Although nearly 40,000 cases of low-lying rectal cancer are diagnosed in the U.S. annually, not all patients qualify for the surgery. “A candidate for sphincter-sparing surgery must be younger, with a normal sphincter and have normal muscle tone in that region,” Dr. Serur said.

“But it’s quite something that a patient can leave the hospital on day 2, have most of their energy back by day 10 to 14 and return to preoperative bowel functioning in three months. That’s quite a different outcome than an open surgery and much different than needing a colostomy bag for the rest of your life.”

In addition to sphincter-sparing surgery, the colorectal team performs transanal total mesorectal excision (TaTME), a new and technically demanding technique that requires a surgeon to extract a cylindrical specimen of rectum and mesorectum through the anus as opposed to the abdomen. The procedure’s popularity is on the rise, as colorectal surgeons have observed positive oncological outcomes, reduced scarring and faster recovery.

“TaTME is a good technique to know, as it offers more options for the patient, but there’s not enough data on its outcomes to make it a gold standard,” Dr. Serur said.

Few colorectal surgeons specialize in such challenging operations, including through the anus instead of the abdomen, because the narrowness of the pelvis leaves little margin for error. The slightest misstep may cause irreparable nerve damage to the bowel or in sexual function.

Posted March 2017

The New Face of Personalized Cancer Care

Posted on by Grace Migliorisi

 

Letter from Steven Brower, MD

Dr Steven BrowerDr. Steven Brower is the medical director of The Lefcourt Family Cancer Treatment and Wellness Center, Englewood Hospital and Medical Center, and a nationally recognized hepatobiliary and gastrointestinal cancer surgeon. He performs complex surgeries related to cancers of the liver, pancreas, stomach, esophagus and rare GI tumors. He has been named as one of New York Magazine’s Best Doctors, Inside Jersey’s Top Doctors and Castle Connolly’s Top Doctors.

Cancer care has entered a new era at Englewood Hospital and Medical Center, where specialists and researchers work together to provide the most technically advanced surgery, radiation therapy and comprehensive chemotherapy with compassionate care. The expansion of The Lefcourt Family Cancer Treatment and Wellness Center, now spanning 185,000 square feet, brings together highly trained subspecialty oncologists within multidisciplinary disease management teams for individual personalized cancer treatment.

The space was designed to enhance patient comfort and convenience, and is infused with the latest technology for the most accurate screening, imaging, diagnosis and cancer staging. Patients with both early-stage and advanced cancers will find experts with many years of experience to treat them with individualized attention to their particular tumor type. Although we are experienced in the most common cancers such as breast, lung, colorectal and prostate, complex cancers of the gastrointestinal, genitourinary, endocrine, head and neck, and skin systems will also receive a personalized approach to diagnosis and treatment.

This treatment approach marries the expertise of our cancer specialists with a commitment to providing the best patient experience and outcome. Bringing cancer care to another level, the center also focuses on conducting clinical trials and research targeting effective treatments, risk for recurrence and survival outcomes.

Here at Englewood Hospital, we make predictions about prognoses and response based on our laboratory work, which uses molecular medicine to create personalized medicine. The laboratory work can reveal components of cancer risk and how patients may respond to treatment. We test a patient’s tumor for genetic abnormalities and prescribe targeted, personalized care.

For instance, some of Englewood Hospital’s patients are at high risk for developing cancer because they have colitis, an inflammation of the colon. Our surgeons are among the most experienced in the region for performing robotic and minimally invasive colorectal surgery that can preserve sphincter function and maintain a normal degree of function. If a damaged colon or rectum must be removed, it may be possible to create a new kind of rectal pouch to preserve the patient’s function and avoid the need for a colostomy.

Englewood Hospital sees 1,500 to 2,000 new cancer patients each year. With stereotactic radiation therapy, our doctors seek to treat the tumor and spare surrounding normal tissue. Our medical oncologists are utilizing high-throughput gene chip-based technology to prescribe the newest molecular target and immunotherapy drugs to extend survival in our patients.

When patients with cancer come to us, we know they’re scared and anxious. We want them to know there’s a team with them every step of the way, and they aren’t alone.

Posted March 2017

Reliance on Immunotherapy Agents Increases, as Does Optimism

Posted on by Grace Migliorisi

 

Immunotherapy has gained wide ground since the FDA approved ipilimumab (Yervoy, Bristol-Myers Squibb) for the treatment of metastatic melanoma in 2011. In the years that followed, the agency approved other checkpoint inhibitors for lung and kidney cancers, Hodgkin lymphoma and urothelial cancer. Researchers at Englewood Hospital and Medical Center are optimistic that the list will continue to grow.

Brian Kim, MD, Hematology/Oncology Specialist
Brian Kim, MD, Hematology/Oncology Specialist

“Though immunotherapy has not yet gained official approval in other tumor types, we’ve seen responses in people with breast cancer, people with gastrointestinal cancers, gynecologic cancers and many others. With this type of strategy, we’re seeing success in some cases that are really unparalleled in the history of cancer treatment,” said Brian Kim, MD, a hematology/oncology specialist at Englewood Hospital. “In trials right now, we’re looking to expand these therapies to virtually every type of cancer.”

Maxwell Janosky, MD, Dermatologic Oncologist
Maxwell Janosky, MD, Dermatologic Oncologist

A major advantage of the agents, which work by disrupting cancer cell signals and leaving them vulnerable to the patient’s own immune system, is that they are generally far more gentle than standard chemotherapy agents.

“I was drawn to the field of immunotherapy during my fellowship when I saw that while cytotoxic chemotherapy has its role, enhancing the immune system to attack the cancer is much less toxic and much better tolerated,” said Maxwell Janosky, MD, a dermatologic oncologist at Englewood Hospital. 

Adverse Effects Need Close Monitoring

The agents, however, are not without their own toxicities that oncologists need to monitor and be ready to treat.

Approved and Unapproved Cancer Immunotherapeutics
Approved and Unapproved Cancer Immunotherapeutics

“Unfortunately, in enhancing the immune system, there isn’t a way to focus the immune system targeting the cancer, so there is a possibility that you can rev up the entire immune system, resulting in flares of inflammation that can be anywhere in the body,” Dr. Kim said.

The effects of excessive inflammation are similar to the symptoms of autoimmune diseases. Some of the most common reactions occur in the GI tract, where the reaction causes inflammation of the colon and diarrhea. Inflammation also can attack the pituitary gland, thyroid and liver, and can cause skin reactions, such as rashes and lesions.

“These inflammatory diseases can happen anywhere. Fortunately, the frequency of these problems has consistently been pretty low throughout all of the trials that have been conducted in immunotherapies so far,” Dr. Kim said. “Reactions that require an interruption of therapy, or treatments to address those side effects, are in the range of only 5% to 15%, which is a much lower frequency of side effects than we see with traditional chemotherapy.”

The treatment for excessive inflammation is an immunosuppressant, typically a steroid. “It’s important to identify these toxicities early and begin treatment,” Dr. Janosky said. “We’re very focused on offering personalized care for our patients, and we have a great multidisciplinary team that helps us do that.”

Of note, the steroidal treatments used to slow down the body’s immune response don’t reduce the effectiveness of immunotherapy. “You can decrease the inflammatory symptoms, but the cancer is still being attacked by the immune system,” Dr. Janosky said.

Researchers at Englewood Hospital have participated in trials that moved immunotherapy agents toward FDA approval, and they have witnessed the results of this treatment firsthand. “We’ve seen breakthroughs for a lot of patients, things we’ve never had before,” Dr. Kim said. “It’s a very exciting time for us as treating physicians, and of course for the patients.”

Dr. Janosky hopes that continued research will extend the drugs to patients with earlier-stage cancers. “We want to increase their cure rate,” he said. “That will result in more cancer survivors.”

Posted March 2017

Staying Safe and Healthy During a Snowstorm

Posted on by Cody

 

When it comes to dealing with the snow and winter storm that his hit our area, it is vital to take proper precautions and measures to stay healthy and safe.

Attire
If you find yourself heading outside during the snow, proper attire is of upmost importance. This includes a tightly woven, preferably wind-resistant coat or jacket; inner layers of light, warm clothing; mittens; hats; scarves; and waterproof boots.

Snow Shoveling
The activity that everyone least looks forward to during a snow storm – shoveling – is not just another annoyance; it can pose serious health risks if you are not careful.  “It is easy to overlook signs and symptoms that may be very serious when you are outside shoveling. Shortness of breath, chest pain, cold sweats could all be indicators of a heart attack, and should be taken very seriously,” says Dr. Hillary Cohen, chief of emergency medicine at Englewood Hospital and Medical Center.

The National Safety Council recommends the following tips to shovel safely.

  • Do not shovel after eating or while smoking
  • Take it slow and stretch out before you begin
  • Shovel only fresh, powdery snow; it’s lighter
  • Push the snow rather than lifting it
  • If you do lift it, use a small shovel or only partially fill the shovel
  • Lift with your legs, not your back
  • If you feel tightness in the chest or dizziness, stop immediately.

“Some people shouldn’t attempt to shovel on their own. Those who are older and those with a history of heart disease may want to consider asking a family member or neighbor to help them. Older people, especially, may be more prone to slip and falls, putting them at greater risk for injury,” says Dr. Barbara Schreibman, associate chief of emergency medicine at Englewood Hospital and Medical Center. “If you have to shovel, take frequent breaks and stop if anything starts hurting. We want to stress that people should not work to the point of exhaustion.”

Warming Up After Being in the Cold
After being outside in the cold, most people rush inside and try to get warm quickly – however, this is not the way to go. When the body goes from one extreme to another, you risk shock, and even heart attack. Take your time, and warm your body slowly.