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North Hills Monthly

Integrated Approach, Satellite Sites Key to UPMC CancerCenter’s Success

Apr 30, 2016 12:05PM ● By North Hills Monthly magazine

When you receive a diagnosis of cancer, you want to make sure that you’re getting the highest quality of care available. This means going where the experts are—which, in the case of UPMC CancerCenter, usually means not having to go far from home. 

“UPMC CancerCenter, in partnership with the University of Pittsburgh Cancer Institute, serves as the clinical arm of cancer care in western Pennsylvania, and includes more than 40 satellite sites throughout local communities,” explains Peter Ellis, MD, deputy director, Clinical Services, and associate chief medical officer, UPMC CancerCenter. “About 15 percent of clinical care happens at Hillman Cancer Center in Shadyside, which is the hub; the remainder takes place at community sites like UPMC Passavant, UPMC St. Margaret, and UPMC Natrona Heights. We all share the same standards and quality metrics, and pride ourselves on providing the very highest level of cancer care in western Pennsylvania.”

Quality and Convenience

Having cancer is hard enough; and having to travel to somewhere unfamiliar just adds to a patient’s difficulties. For this reason, UPMC CancerCenter sites are located in neighborhoods throughout the region. 

These network sites offer the same level of clinical services as their counterparts in the city, and treat almost all types of cancers, with the exception of conditions that require extremely specialized care. Acute leukemia and cancers that require stem cell transplants, for example, are treated at Hillman Cancer Center or UPMC Shadyside. 

“Of the 75,000 patients that are treated at UPMC CancerCenter sites each year—25,000 to 30,000 of which are new—approximately 85 percent are treated in our satellite facilities,” says Stanley Marks, MD, chairman, UPMC CancerCenter. “Our goal is to keep this care close to home, because we want patients to feel comfortable in an area that they’re familiar with and that is easier for them to reach.

“Even if they do come to Hillman or UPMC Shadyside for tertiary or quaternary care, we try to get them back to their communities as soon as we can,” he adds. “They may come here to get a specific level of expertise in a particular area, but they are able to get their follow-up care closer to home.”

In order to ensure that all patients receive the same high level of care no matter where they are treated within the system, UPMC invested 11 years and $15 million into creating the Via Oncology Pathways program. “We set up committees that included academic and clinical experts in diverse oncology fields, such as prostate, colon, lung, gastric, esophageal, and breast cancers, and asked them to define the best evidence-based care,” explains Dr. Ellis. “We then embed that into a decision-support tool that is available to all UPMC CancerCenter oncologists.” The committees in each medical specialty meet every quarter to update the Pathways with the most current evidence-based therapies. 

“To the extent that we can standardize care, we do, but each location still also has its own personality,” adds Dr. Ellis.

The hospitals also have tumor boards that meet weekly to allow doctors from numerous disciplines to discuss cases. A typical meeting may include radiation oncologists, medical oncologists, general surgeons, thoracic surgeons, pathologists, radiologists, and family practitioners. “One of the biggest advantages of the tumor board is that it enables us to take a multidisciplinary approach when we sit down and review cases,” says Kiran K. Rajasenan, MD, clinical assistant professor, Medical Oncology, UPMC Passavant. “Patients benefit because they are able to get the opinions of multiple doctors, as well as a consensus on treatment.”

Working with other experts within the hospital, as well as utilizing the breadth of knowledge at Hillman Cancer Center when needed, physicians at community sites are able to take an integrated approach to a patient’s care. “Cancer care is not just surgery or radiation or chemotherapy; there are different sequences of events at different stages,” explains Alex Chen, MD, clinical associate professor, Radiation Oncology, UPMC Passavant. “By taking a multidisciplinary approach, we can discuss how to treat an advanced tumor; for example, whether it would be better to shrink the tumor with chemotherapy and radiation first and then do surgery, or to proceed with surgery followed by chemotherapy or radiation. This level of coordination allows us to design the most appropriate treatment plan.”

Breadth of Services

Both UPMC Passavant and UPMC St. Margaret are able to provide patients in the northern communities with the latest radiation treatment modalities. Radiation therapies and services include brachytherapy, image-guided radiation therapy (IGRT), intensity-modulated radiation therapy (IMRT), On-Board Imager® (OBI), RapidArc®, and respiratory gating. “Respiratory gating therapy allows us to treat the patient during certain phases of respiration in order to increase the homogeneity of radiation, and decrease the amount of lung and heart radiated,” explains Ryan Smith, MD, director of Radiation Oncology, UPMC St. Margaret. “These therapies are used to treat patients with lung cancer, upper abdomen malignancies, and breast cancer.” Initial consultations and office visits are available for radiation oncology patients at UPMC Natrona Heights, in addition to the full radiation oncology services available at UPMC St. Margaret.

All three sites offer chemotherapy infusion services including biological therapy administration (BRM), chemotherapy administration, colony stimulating factors (CSF), Interferon (IFN), Interleukin, and monoclonal antibodies (MoAb). 

“From a chemotherapy standpoint, all of the latest drugs that you hear about on the news are available here, including targeted agents like monoclonal antibodies,” says Dr. Rajasenan, adding that physicians are moving away from the cell-killing form of chemotherapy that has been used for the past 40 years to utilize more targeted agents.

“We’ve seen a lot of growth in the last couple of decades at UPMC Passavant, and a lot of significant investment to bring the surgical oncology subspecialty here,” he continues, adding that most communities do not have access to such a wide array of surgical subspecialties outside of a major hospital facility. “More than 10 years ago, Dr. David Geller did the first liver metastases resection at UPMC Passavant; now we do them routinely.” 

Another positive is that patients who want to enroll in clinical trials have that ability at many of the community sites. “We’ve been doing clinical trials here for decades,” says Dr. Rajasenan, adding that a full-time protocol nurse on staff makes that possible. 

“We have the ability to recruit patients into almost any trial in the UPMC system, whether they are multicenter trials or national group studies,” adds Dr. Smith, who, along with his partner, Colin Champ, MD, have initiated their own in-house trials in the areas of prostate cancer and adjunct therapies. 

Making Patients Feel at Home

While UPMC Passavant, UPMC St. Margaret, and UPMC Natrona Heights have the breadth of services and experience needed to provide top-notch cancer care, they also have something more. “Patients just feel welcome here,” says Dr. Rajasenan. “I have a patient from Ellwood City, for example, who refuses to go into the city, but will come to the North Hills for treatment. Patients are sometimes intimidated by the sheer volume and size of the facilities in the city; they don’t feel that way here.”

Edward Malloy, MD, medical oncologist at UPMC Natrona Heights, agrees that sometimes a smaller setting is just a better fit for the patient. “A lot of times when they’re going to bigger centers, they feel lost in the shuffle,” he explains. “Because of our size, they feel more comfortable, and our team works really hard to keep the patient in the center of care.

“Apart from the technology, and all the bells and whistles, what really sets us apart are our physicians,” he adds. “Their compassion and professionalism is unsurpassed.”

Patient satisfaction is monitored regularly, with Dr. Marks receiving monthly reports from every site. “Patient satisfaction scores are in the 90th percentile across the board, and some of the highest scores come from these community sites,” he says. “People like being treated in these smaller facilities; they like staying in their own environment.”

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A Patient’s Story

 Michael McLane, 50, of McCandless, is a huge Steelers fan, so he didn’t think much of it when he woke up exhausted the Monday after attending the AFL championship game. By Friday, however, he wasn’t feeling better and jaundice had set in.

“Thank goodness I went to see my doctor, who found a tumor against my bile duct,” he says.
“I was diagnosed with pancreatic cancer, which is also known as the silent killer because you usually don’t know you have it until it’s too late.”

Referred to Dr. Rajasenan, a medical oncologist at UPMC Passavant, Mr. McLane was given a choice of treatment options, including the option to undergo six cycles of folfirinox chemotherapy prior to surgery, followed by more chemotherapy afterwards. “First, I asked if I could take my nephew to the Super Bowl because I already had tickets,” he says. “When they said yes, then I told them to bring it on.”

Though it was a very arduous treatment to undergo, Mr. McLane said that he had support at every step. “I had my family and friends, and then I had everyone at the UPMC Passavant CancerCenter,” he says. “Dr. Rajasenan and the nurses there welcomed me every time with open arms. It’s weird to say that it was fun, but they made it that way. They were always there cheering me on. 

“There were times when I said that I didn’t think I could do it, and didn’t want to come in,” he adds. “They said, ‘Yes, you can. We’ll come and get you if we need to.’ They kept me motivated and inspired, and I knew I couldn’t quit.”

After Mr. McLane completed all six cycles, he underwent Whipple surgery, performed by
Allan Tsung, MD, and was back home in a week. “Here I am five years later and I feel great,” he says. “I still keep in touch with Dr. Rajasenan a couple of times a year, and I can’t say enough about the nurses and staff. 

“It was a team effort, and I couldn’t have done it without them,” he adds. “The fact that we have a top cancer center right in our backyard is phenomenal, and I couldn’t be any more thankful.”