Elevating Oncology: Vassar Brothers Medical Center Delivers Comprehensive Cancer Services to the Mid Hudson Valley

By Hannah Stuart
Friday, December 16, 2016

Building on a collaborative team of experienced, highly trained and compassionate specialists, Vassar Brothers Medical Center has broadened the scope of advanced services it offers and is equipped to provide the full spectrum of oncology care to patients in the Mid Hudson Valley.

The growth of Health Quest Medical Practice, P.C. (HQMP), through the addition of clinicians with wide-ranging expertise, has expanded the medical oncology team at Vassar Brothers Medical Center’s Dyson Center for Cancer Care. Patients now have access to specialists and subspecialists who jointly tailor treatment plans to their specific tumor type or disease state, fostering improved coordination of care and peace of mind. In addition, the multidisciplinary approach combined with the availability of clinical trials means patients may receive leading-edge care without the expense and other logistical burdens involved in traveling to facilities outside the region.

Medical Oncology

A primary focus of oncology care at Vassar Brothers Medical Center is collaboration. One way Vassar Brothers Medical Center ensures rigorous collaboration and precisely tailored treatment is by following a tumor-specific model of care that allows patients to see multiple specialists on the same day.

Cliff Connery, MD, FACS, FCCP, Medical Director of the Dyson Center for Cancer Care and Medical Director of the HQMP Division of Thoracic Oncology, discusses a plan of care with a patient.

A team member prepares a patient for her medical oncology visit by updating her electronic medical record.

“If, for example, a patient has a new diagnosis of a lung mass or lung cancer, he or she would go to the multidisciplinary thoracic clinic,” says James Leonardo, MD, PhD, FACP, Medical Director of Medical Oncology at HQMP. “The providers participating in that clinic all have expertise in lung cancers. Patients see surgery, radiation and medical oncologists with unique experience in that area. That’s where the tumor specificity comes in — as cancer treatments become so complex, it is now a necessity to have local specialists with a high degree of knowledge about specific types of cancer. We have those here.”

The tumor board approach is used for thoracic cancer, esophageal cancer and breast cancer. Gastrointestinal tumor boards are expected to be added soon, and Dr. Leonardo anticipates the use of this approach will grow rapidly.

“Tumor boards garner more input from the physicians, and we have the imaging and testing performed the same day,” says Cliff Connery, MD, FACS, FCCP, Medical Director of the Dyson Center for Cancer Care and Medical Director of the HQMP Division of Thoracic Oncology. “With all of this being completed quickly, patients with complex cases receive treatment recommendations that take into account all areas of their care in a very timely manner.”

Surgical Oncology

Over the past decade and a half, many surgical procedures for early-stage lung cancer were performed using video-assisted thoracoscopic surgery (VATS), as it had equivalent outcomes to open lobectomy but improved recovery by reducing patients’ pain level and length of hospital stay. However, robotic-assisted techniques Vassar Brothers Medical Center has incorporated represent a further evolution of surgical oncology, speeding recovery even more and preserving a greater amount of normal tissue than is spared by conventional methods.

James Leonardo, MD, PhD, FACP, Medical Director of Medical Oncology at HQMP, sees a patient at the Dyson Center for Cancer Care.

Angela Keleher, MD, FACS, Director of the Dyson Breast Center and Director of Breast Surgery at Vassar Brothers Medical Center, and Gregory Zanieski, MD, collaborate on a patient case at the Dyson Breast Center.

“Robotics allow you to complete more cases in minimally invasive fashion,” Dr. Connery says. “This helps in particular with patients who have other medical conditions, as they frequently tolerate minimally invasive procedures better than other approaches.”

Vassar Brothers Medical Center has two da Vinci Surgical systems, and as Dr. Connery notes, the surgeons who utilize the systems have a high level of education and training regarding robotic-assisted procedures. While the systems markedly expand Vassar Brothers Medical Center’s surgical capabilities, the surgeons’ knowledge and expertise in guiding the technology is ultimately the most vital factor in promoting excellent patient outcomes, he adds. Our surgical oncologists, in particular Drs. John Choi, Pranat Kumar and James Nitzkorski, have extensive experience in the use of robotics in colorectal surgery.

In Thoracic Oncology a number of surgeries are performed at Vassar Brothers Medical Center using a minimally invasive approach — often with the da Vinci Surgical System:

  • Diaphragm reconstruction
  • Limited resection for lung cancer
  • Segmentectomy
  • Lobectomy
  • Thymectomy
  • Esophagectomy and esophagogastrectomy

Other cancers treated surgically at Vassar Brothers Medical Center include breast cancer, colorectal cancer, gastrointestinal and gastric cancers, liver cancer, pancreatic cancer, melanoma, sarcoma, anal cancer, and rare or recurrent tumors.

Isolated limb perfusion is one specialized oncology procedure that Health Quest Medical Practice, P.C. surgical oncologist Dr. Nitzkorski initiated at Vassar Brothers Medical Center. This procedure is indicated based on the collaborative findings of the tumor board and may be performed when a cancer such as melanoma has spread throughout an extremity. Providers isolate the blood supply and administer chemotherapy into the limb. At the beginning of the procedure, which typically takes approximately one hour, the limb is heated. When the limb and tumor site reach a specific temperature, chemotherapy is injected at a high concentration. The site-specific nature of this procedure reduces potential side effects outside the treatment area.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is another advanced treatment option Vassar Brothers Medical Center offers locally for cancer patients. HIPEC is indicated for certain types of abdominal cancers that can be treated by surgical removal of the cancer followed by perfusion of a high dose of chemotherapy in the abdomen. Vassar Brothers Medical Center is one of the few hospitals in the United States that utilizes this therapy for cancers in the chest as well.

“Certain types of tumors can spread to the lining of the chest wall but haven’t spread throughout the bloodstream,” Dr. Connery says. “For instance, a thymoma occurs when malignant cells form on the outside surface of the thymus. That tumor sheds cells to the lining of the chest cavity. With HIPEC, after you remove all of the visible tumor components, you place a tube in the chest to perfuse chemotherapy. An apparatus that is a bit like a heart-lung machine pumps this fluid into the chest at a temperature higher than the normal body temperature, and this allows chemotherapy in high concentrations to invade the chest lining. It’s used for limited cancers such as mesothelioma, some types of appendiceal carcinomas and certain types of tumors that spread along the lining of the abdomen.”

“At the Dyson Center for Cancer Care, every patient is viewed as a survivor. From day one, social workers and dietitians who are specifically trained in the problems of cancer patients meet with virtually all new patients. We have specialists in palliative care and symptom management, as well, and all of our advanced nurse practitioners are trained as nurse navigators for our specialty clinics. In addition, all of our oncology nurses are certified by the Oncology Nursing Society.”
— James Leonardo, MD, PhD, FACP, Medical Director of Medical Oncology at Health Quest Medical Practice

Vassar Brothers Medical Center will be adding another thoracic surgeon as well, and anticipates the team will expand to include a head and neck cancer surgeon with reconstructive capabilities.

“We’ve broadened the scope of treatment in other disease areas, including adding a top-notch, fellowship-trained hepatobiliary surgeon, Dr. Ryan Swan, to join our surgical oncology team,” Dr. Connery says. “These advances have enabled us to provide more uniform delivery of cancer care.”

Radiation Oncology

Radiation oncologists are a key part of the treatment team at Vassar. Having advanced radiation oncology treatments and technology available close to home makes cancer treatment significantly more convenient for patients, who often have to travel for daily radiation treatments. Technologies such as stereotactic radiation, which precisely targets malignancies in three or five doses for patients who have small tumors and for whom surgery is suboptimal, are among the services Vassar Brothers Medical Center radiation oncologists provide. Microwave ablation, a therapy that can be provided by surgeons or interventional radiologists, is another technique that can be used to treat these tumors in certain situations.

Another of the highly specialized therapies available is intraoperative radiation, which unites the capabilities of the surgical and radiation oncology teams. Surgeons remove a tumor during a lumpectomy, and the patient is simultaneously given a one-time dose of radiation directly to the area where the cancer was located.

Also performed at the Dyson Center for Cancer Care is a procedure for which the center created a protocol that was approved by the state: radioactive seed localization. Utilized for breast cancer patients in place of wire localization for non-topical tumors, radioactive seed localization involves placing iodine-125 radioactive seed in the tumor so a probe can detect the tumor’s precise location, says Angela Keleher, MD, FACS, Director of the Dyson Breast Center and Director of Breast Surgery at Vassar Brothers Medical Center. The surgeon then knows exactly where to make the incision to resect the tumor and remove the seed. This procedure can be performed more quickly than wire localization.

Breast Cancer Services

The Dyson Breast Center has achieved accreditation by the National Accreditation Program for Breast Centers (NAPBC) and is held to the highest standard of patient care for patients with diseases of the breast. The comforting space that encompasses the imaging suite and breast care services — including surgery and access to social workers and navigators — is found all in one location. This allows patients to schedule imaging and follow-up appointments for the same day, and to have procedures such as sentinel node biopsies performed on an outpatient basis. Mastectomies and reconstructions are also performed at the facility, with patients staying overnight at the Vassar Ambulatory Surgery Center (VASC) in a soothing, spa-like environment with private rooms.

Dr. Leonardo collaborates with his team at the Dyson Center for Cancer Care.

“Our cancer program has grown in numbers, but also in providers and specialties, and that’s what we want,” Dr. Keleher says.

“For surgical patients, we work with an anesthesiologist who is specifically trained to provide nerve blocks,” Dr. Keleher says. “Patients with nerve blocks require less narcotics, experience less pain, and get up and move around more quickly, which improves their recovery time.”

Vassar Brothers Medical Center also partners with other specialists to offer procedures that patients wouldn’t otherwise have access to locally. For instance, the medical center is unique in the area in working with highly specialized plastic surgeons from New York City who are specifically trained to perform DIEP flap breast reconstruction, Dr. Keleher says.

A DIEP flap reconstruction involves cutting fat, skin and blood vessels from the wall of the lower belly — avoiding cutting or removing muscle — and microsurgically reattaching those vessels to the blood vessels in the chest. This approach allows the patient to recover more quickly and enhances cosmesis.

“Traditional replacement involves a rotational flap, so this is highly specialized in that you’re disconnecting it from the body and its blood supply and then reconnecting it to another blood supply under the microscope,” Dr. Keleher explains. “Patients are evaluated to ensure they’re appropriate candidates for the surgery. These surgeons completed a fellowship in microvessel surgery and then specialized in breast surgery. There are only a few such specialists in the country.”

“Education is a vital component of what we do, including educating the community about their risk levels and the importance of screenings. In addition, we’ve been providing CME courses for physicians in the area, and we are involving members of other cancer programs in the state so they understand our capabilities. At the end of the day, it’s about ensuring that patients and physicians alike are aware of the services we offer, and how we can partner with them to provide a comprehensive level of oncology care.”
— Cliff Connery, MD, FACS, FCCP, Medical Director of the Dyson Center for Cancer Care and Medical Director of the Health Quest Medical Practice Division of Thoracic Oncology

Dr. Keleher collaborates with the plastic surgeons, who share office space at the Dyson Breast Center, to determine the appropriate mastectomy and reconstruction techniques for each patient. In some cases, the surgeons can remove the cancer and immediately perform the reconstructive procedure, reducing the number of surgeries a patient must undergo.

The Dyson Breast Center’s dedication to improving patient outcomes and satisfaction is also evident in its utilization of breast tomosynthesis, which increases early breast cancer detection and decreases unnecessary callbacks. In addition, patients have opportunities to participate in national clinical trials or speak to a genetic counselor about their personal risk levels for breast cancer. A social worker navigator connects patients to supportive services they may require, including an onco-nutritionist and massage therapist, and patients can access other resources as well, such as financial assistance professionals or services that can help them obtain prostheses or wigs.

Easing the Burden on Patients

The challenges of a cancer diagnosis are amplified for patients when they must seek treatment and follow-up care in major metropolitan areas a significant distance from the communities where they and their families live and work. Vassar Brothers Medical Center’s comprehensive level of services means patients can receive the high-quality, specialized oncologic care they need in a location that is convenient for them and that fosters close collaboration with their referring physicians.

“Our cancer program has grown in numbers, but also in providers and specialties, and that’s what we want,” Dr. Keleher says. “Patients going through cancer shouldn’t have to travel hours to get to a place where they feel they will receive quality care. We’re providing state-of-the-art diagnosis, treatment and supportive services in our patients’ backyard, and in a personalized, compassionate manner. We know the area, and we want to take care of this community. That’s our goal, and we’ve brought together the components necessary to achieve it.”

For more information, visit healthquest.org/cancer.