Expert clinicians and the latest technological treatment advances make Health Quest’s Division of Thoracic Oncology at Vassar Brothers Medical Center a comprehensive, multidisciplinary care program designed to create better outcomes for lung cancer patients throughout the region.
Lung cancer remains the leading cause of cancer death in the United States, with a five-year survivorship of less than 16 percent, according to the American Lung Association. The New York Department of Health reports nearly 14,000 lung cancer diagnoses and approximately 9,000 mortalities from the disease each year, making the condition an urgent local concern. Health Quest’s Vassar Brothers Medical Center — an American College of Surgeons Committee on Cancer-accredited Comprehensive Community Cancer Center — has demonstrated its commitment to meeting this community healthcare need with the establishment of its Division of Thoracic Oncology. From screening and advanced imaging diagnostics to the latest robotic- and video-assisted surgical treatments and rehabilitation, this multifaceted program combines components of survivorship, support and education to render the highest caliber of cancer care.
“Health Quest has a long history of providing excellent cancer care for the community, both in the hospital and in outpatient areas, with skilled clinicians working together collaboratively,” says Cliff P. Connery, MD, FACS, Medical Director for the Dyson Center for Cancer Care at Vassar Brothers Medical Center and Medical Director for Health Quest Medical Practice’s Division of Thoracic Oncology. “We are committed to providing the best possible cancer care by enhancing screening, developing screening protocols for lung cancer in particular, and working effectively together to develop a multidisciplinary team.”
Providing the full care spectrum of thoracic oncology — cancers and diseases of the lung, esophagus, chest wall, lymph nodes, diaphragm and pericardium — Health Quest is changing outcomes for the better for patients from the Hudson Valley and beyond.
“We’ve seen patients migrate from New York City to Vassar Brothers as opposed to traveling out of this region for their care,” says Dimitrios Papadopoulos, MD, Medical Director for Health Quest Oncology. “It’s a testament to the quality of care Dr. Connery and the Thoracic Oncology Division have brought to the Hudson Valley.”
Lung Cancer Screenings
In recognition of Health Quest’s commitment to safe and efficient lung cancer screenings, Vassar Brothers Medical Center earned certification earlier this year as a Screening Center of Excellence by the Lung Cancer Alliance, a leading advocacy group. Lung cancer screenings are available at all three Health Quest sites: Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center.
“We know when using the strictest criteria for screening that we are not able to diagnose all patients who may have lung cancer. We have to participate in research to better define a patient’s risk categories, including genetics and family history, to determine a more appropriate definition of which patients should undergo screening.”
— Cliff P. Connery, MD, FACS, Medical Director for the Dyson Center for Cancer Care at Vassar Brothers Medical Center and Medical Practice Director for Health Quest’s Division of Thoracic Oncology
“We are participating with the International Early Lung Cancer Action Program (I-ELCAP), which originated the concept of lung cancer screenings and tracks diagnoses and data management,” says Dr. Connery, who took the helm of the program last year. “With programs in cancer care and support, smoking cessation and nurse navigation, we have already met the Lung Cancer Alliance requirements.”
In accordance with the Centers for Medicare & Medicaid (CMS) guidelines for lung cancer screening with a low-dose CT scan, patients meeting certain criteria may be eligible to have the screening cost covered by insurance, if they:
- Are current smokers or have quit smoking within the previous 15 years and are between the ages of 55–77.
- Have a history of smoking the equivalent of a pack of cigarettes per day for 30 years.
Recognizing that not all patients at high risk for lung cancer fall under the strict CMS guidelines for lung cancer screenings, Dr. Connery has devised more categories to make screenings accessible within the Health Quest program to other patients with elevated risk factors.
“We have other modes of entry for patients who have less smoking exposure but may have significant secondhand smoke exposure, occupational exposure or a family history of lung cancer,” Dr. Connery says. “We look at biomarkers to risk-stratify patients, which allows for further research. Patients sign a consent for the screening, but we believe tracking this data can better define the best candidates.”
Dr. Connery cites compelling reasons to expand lung cancer screenings at Health Quest. Lung cancer data does not always support the stereotype of smoker as cancer patient. For example, more than 20 percent of women with lung cancer are not smokers. The diversity of potential patients highlights the importance of early detection for increased survivorship, especially as most screenings are performed on asymptomatic patients.
“Patients who are screened and have screening-identified lung cancer are usually diagnosed in earlier stages when the disease is quite curable,” he says. “I-ELCAP registry data suggests that when lung cancer is identified earlier, survival can be as high as 80 percent at 10 years. Screenings must be done in a careful setting by professionals trained in screening asymptomatic patients to minimize harm and maximize survivorship.”
Dr. Connery (L) and Rohit Shahani, MD, FACS, FACC, plan a procedure.
Major components of Health Quest’s Thoracic Oncology program are the advanced imaging technology and expert clinicians in place to diagnose cancers in their earliest stages through minimally invasive procedures, including:
- Bronchoscopy: the process of inserting a flexible tube with a camera through the mouth or nose to assess and evaluate the bronchi.
- Mediastinoscopy: the evaluation and sampling of lymph nodes with a scope through a small neck incision.
- Navigational bronchoscopy: a procedure using a specialized electromagnetic-guided scope that can achieve further insertion into bronchi otherwise inaccessible by normal bronchoscopy.
- Thoracoscopy: a modality using a scope with a camera inserted through a small incision in the chest to evaluate the outer lungs and interior wall of chest.
- Thoracotomy: the use of an incision between the ribs that allows the surgeon to perform the full range of procedures needed to treat chest disorders.
The navigation bronchoscopy technology extends the reach of diagnostic capabilities.
“We have a well-trained and experienced radiology team working across our unified system to provide patients with an accurate diagnosis,” Dr. Connery says. “When there’s an abnormality in screening, the next step is follow-up imaging. If a patient requires a biopsy, one of our interventional radiologists may perform a percutaneous procedure through the skin with a needle, usually guided with a CT scan or ultrasound, to examine a lesion.”
VATS and da Vinci
Cliff P. Connery, MD, FACS, Medical Director for the Dyson Center for Cancer Care at Vassar Brothers Medical Center and Medical Director for Health Quest Medical Practice’s Division of Thoracic Oncology, works at the da Vinci robotic console.
Once patients receive a diagnosis of lung cancer, esophageal cancer or other thoracic disease, surgical intervention is often the first step of the treatment process. At Health Quest, Dr. Connery and the thoracic surgeon team — Rohit Shahani, MD, and Peter Zakow, MD — employ leading-edge video-assisted thoracic surgery (VATS). Dr. Connery also employs robotic technology, utilizing the da Vinci Si HD and Xi Surgical Systems at Vassar Brothers Medical Center to perform the latest minimally invasive surgical techniques.
VATS utilizes a series of small incisions for insertion of minuscule cameras that relay high-definition imagery back to a video-monitoring system and provide the means to optimally stage the cancer, a critical first step to treat the patient, Dr. Connery notes.
Health Quest’s commitment to providing specialists with robotic technology is evident with its purchase of two advanced da Vinci robotic surgical systems. When Dr. Connery joined Health Quest, his vision was to create a robotic-assisted thoracic surgery program. The technological advances of the da Vinci system provide Dr. Connery and other surgeons the highest caliber of precision, high-definition imaging, allowing for smaller incisions and less blood loss while performing surgical interventions.
“The da Vinci Xi device has more capabilities for thoracic surgery, including specialized staplers, dexterity and three-dimensional visualization,” he says. “Having the ability to do a minimally invasive approach, whether it is video- or robotic-assisted, is vital. Oncology outcomes are equivalent to open surgery; however, in general there are fewer complications, shorter hospital stays, less pain and faster recovery for patients with the minimally invasive approach.”
Lobectomy, surgical removal of a lobe of the lung, and lymph node dissections are the most common procedures utilizing the da Vinci or VATS technologies, depending upon the diagnosis and patient needs. When treating patients with esophageal cancer, Dr. Connery teams with James Nitzkorski, MD, a surgical oncologist specializing in gastrointestinal malignancies who is also trained in the use of robotics.
“We have the expertise and experience to deploy these tools when appropriate,” Dr. Connery says. “We work together to give cancer patients quality of life and time.”
High-risk lung cancer patients are also evaluated using a personalized multidisciplinary team approach.
“We have an outstanding radiation oncology team at Health Quest. Knowing how critical effective collaboration is to providing excellent care made it easy for me to decide to come here from Manhattan,” Dr. Connery says.
“Dr. Connery is a very sought-after surgeon and could have chosen to practice in a number of academic settings,” says Sandi Cassese, Vice President of Oncology for Health Quest. “We’re fortunate that he brought his expertise to the community hospital setting, knowing that we would give him all the support necessary to implement this lifesaving program.”
Stereotactic Ablative Radiation
Oncology treatments with stereotactic ablative radiation are another component of Health Quest’s comprehensive thoracic oncology program that can be targeted and tissue-sparing.
“Many factors come into play to determine the treatment regimen,” Dr. Connery says. “For high-risk lung cancer patients or for those with a metastasis, stereotactic ablative radiation therapy can be directed by a complex computer-generated plan to provide a high-dose radiation beam to a very small area, accounting for movement while a patient is breathing. Patients receive three to five treatments, and these certain techniques and maneuvers limit radiation collateral damage for healthy tissue surrounding the cancer.”
For cancers that spread to the lining of the chest wall, such as thymomas, Dr. Connery has seen positive results utilizing an innovative treatment of intraoperative hyperthermic chemotherapy perfusion, available at Health Quest.
“A malignancy that starts in the thymus gland in front of the heart and high in the chest almost to the neck may shed tumor cells into the chest wall,” Dr. Connery explains. “In those occasions when the cells spread into the chest space, it is extremely difficult to remove all of the disease. Therefore, we remove the visible tumor and treat the microscopic disease area with high-dose chemotherapy.”
A pump pushes the chemotherapy fluid at a rate of one liter per minute through the affected chest area at a heated and controlled temperature that can also be effective for patients with mesothelioma and ovarian carcinomas, according to Dr. Connery.
“The heat and high-dose chemotherapy spread throughout the lining of chest,” he says. “We can kill the residual disease cells without delivering high doses of chemotherapy directly into the bloodstream. We have this chemotherapy as an option if the primary disease site is controlled, and the persistent disease in the chest can be removed either with standard open surgery or with minimally invasive, robotic surgery techniques and then treated with hyperthermic-perfused chemotherapy. We can collaborate and design a treatment for the patient that makes sense, taking into account the extent of disease and the patient’s wishes to determine the best combination of treatments and support.”
Health Quest earned designation as a Survivorship Training and Rehabilitation (STAR) certified cancer program by Oncology Rehab Partners, a national cancer advocacy group. The STAR program certification denotes the use of a multidisciplinary approach to meet cancer patients’ needs through provider training, treatment protocols and patient outcomes combined with continuing education.
The multidisciplinary rounding team includes physicians, advanced practice professionals and other staff.
“Providers from different disciplines — medical oncologists, surgeons, nurses, physical therapists, social workers and nutritionists — receive specific training in the collaborative treatment of cancer patients to identify areas where patients might need more resources,” Dr. Connery says. “For example, a team member may have more specific training to know a certain physical therapy technique is better suited for a chemotherapy patient. From a personal standpoint, while working recently with a cancer patient who was facing many challenges, we introduced additional resources of emotional and clergy support as well as nutritional support because of our STAR training. It is encouraging to see such a positive impact this early into the program.”
Dr. Connery (L) and James Nitzkorski, MD, FACS, review a radiation treatment plan before an esophageal surgical procedure.
It is now recognized that survivorship is a distinct phase of cancer care. Health Quest is developing its survivorship program to enhance patient offerings through rehabilitation services, support and education.
“The American College of Surgeons Commission on Cancer has recognized the value and is requiring programs to establish true survivorship plans,” Dr. Connery says. “It is one thing to cure a patient’s cancer, but we need to continue with regular screenings and provide guidance as to what to expect and do for a healthier lifestyle. Sonya Alyea, NP, conducts advanced assessments of patients with different cancer diagnoses to develop a program more attuned to their needs and involve their primary care physicians as a complement of care.”
Following patient outcomes through participation in the Society of Thoracic Surgeons National Database, care protocols are designed to allow Health Quest to meet or exceed benchmarks set at the nation’s top centers, while enriching the patient experience from screening and prevention to diagnosis, treatment and survivorship.
“Outcomes are the most important, and as we evaluate our quality measures, we always add an element of compassion,” Dr. Connery says. “We look after our patients as we would take care of our own families. We provide a high level of care and are frank with patients when necessary as to what we can achieve. We provide the resources to enable them to make informed decisions. A patient’s world stops with a cancer diagnosis; however, we have an expert team to tailor a plan to fit the patient’s needs and provide the highest quality of life possible.”
It all starts with the office team, providing ready access and helping to coordinate care.
Health Quest’s Thoracic Oncology team places importance on scheduling to expedite appointments and test results, speeding the initiation of cancer treatments.
“We work with referring physicians within the community and beyond, regardless of the geographic area, to treat patients and maintain a high level of communication, which can measurably improve outcomes,” Dr. Connery adds. “We create plans together with patients, and it is amazing how strong and how grateful cancer patients are to maximize their good days and plan for more good days ahead.”
For more information on Health Quest’s comprehensive thoracic oncology program and advanced lung cancer screenings, visit healthquest.org/cancer.