NewYork-Presbyterian Hudson Valley Hospital’s Cheryl R. Lindenbaum Comprehensive Cancer Center brings the expertise and innovation of one of New York’s three NCI-designated Comprehensive Cancer Centers to patients in the Hudson Valley region, thanks to its collaboration with NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC) and ColumbiaDoctors, its faculty medical practice. Already known for their dedication to providing patients and their family members with the highest quality of cancer care in a warm and nurturing setting, their goal is to build a partnership with their patients during every phase of care, from diagnosis through treatment and into survivorship.
A few years ago, leaders at both NewYork-Presbyterian and NewYork-Presbyterian Hudson Valley Hospital recognized an opportunity to address one of the primary burdens of care for cancer patients: access to care at the academic medical center level. The institutions envisioned a collaboration that would allow patients to remain close to home, family and loved ones while receiving treatment and ongoing management, along with seamless entrée to the NCI-designated Herbert Irving Comprehensive Cancer Center at NYP/CUIMC in Manhattan for complex or clinical trial-based experimental therapies. In 2016, that vision became reality when three NYP/CUIMC clinicians — medical oncologists Martin Oster, MD, and Mark B. Stoopler, MD, and hematologist/oncologist J. Gregory Mears, MD — began treating patients in the Cheryl R. Lindenbaum Comprehensive Cancer Center at NYP Hudson Valley Hospital.
“Historically, many patients preferred to go to New York City for the level of expertise that the larger institutions offered, but now that my colleagues and I are at NewYork-Presbyterian Hudson Valley Hospital, we bring that same proficiency to the Hudson Valley community,” says Dr. Stoopler, an attending physician at NYP/CUIMC and Associate Professor of Medicine at Columbia. “If patients are willing to travel to Columbia, I can facilitate their entry into a clinical research program. This offers tremendous continuity of care for our patients.”
Forums for Consultation and Collaboration
Equally valuable for patients is the multidisciplinary nature of the cancer care they receive at NYP Hudson Valley Hospital. At the cancer center’s weekly tumor board meetings, all disciplines — surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, nurses and other clinicians — come together to discuss optimal approaches to treatment for newly diagnosed patients, as well as those for whom new issues have arisen during the course of therapy.
(From left) Martin Oster, MD, medical oncologist with the NewYork-Presbyterian Hudson Valley Hospital Cheryl R. Lindenbaum Comprehensive Cancer Center, attending physician at NYP/Columbia University Irving Medical Center and Associate Professor of Medicine at Columbia, and J. Gregory Mears, MD, medical oncologist and hematologist with the NYP Hudson Valley Hospital Cheryl R. Lindenbaum Comprehensive Cancer Center, attending physician at CUIMC and Professor of Medicine at Columbia, work closely with their patient to answer questions and fully describe the treatment options and the course of treatment.
“The tumor board is a comprehensive panel,” says Dr. Mears, Professor of Medicine at Columbia. “It’s an opportunity for specialists with varied perspectives to discuss what’s new in the literature and any novel therapies that may be available. It has educational, academic and clinical aspects.”
Dr. Stoopler hosts an additional tumor board dedicated to thoracic oncology, modeled after one he started at the Herbert Irving Comprehensive Cancer Center in the late 1980s and has coordinated since then. The NYP Hudson Valley thoracic oncology tumor board meets regularly to focus on these particular cancers.
“Most institutions hold a general tumor board, but this is a focused group of experts,” he says. “In addition to the treatment of lung cancer, the Thoracic Oncology Team provides multidisciplinary treatment and care to patients with esophageal cancer, where patients need specialized care given the illness.”
“My colleagues and I are always accessible to patients’ primary care physicians because care coordination is vital to disease management. An important part of the care we provide is the way in which we treat patients as whole people. We work closely with their primary physicians to coordinate and understand how cancer treatment intersects with therapies for other conditions.”
— J. Gregory Mears, MD, hematologist/oncologist at NewYork-Presbyterian Hudson Valley Hospital and Professor of Medicine at Columbia
Leading-edge Thoracic Oncology
Each of the three NYP/CUIMC medical oncologists who are based in NYP Hudson Valley Hospital specializes in treating a specific form of cancer. Dr. Mears, a hematologist, specializes in leukemia, lymphoma and other blood diseases as well as breast cancer, and Dr. Oster specializes in head and neck cancer in addition to breast cancer. Dr. Stoopler says the most exciting advances in his area of expertise, thoracic oncology, have occurred in lung cancer, especially in the realm of personalized medicine.
(From left, standing) Dr. Oster, who specializes in breast and head and neck cancer, confers with Andrew Ashikari, MD, FACS, surgical oncologist with the NewYork-Presbyterian Hudson Valley Hospital Ashikari Breast Center, Chief of Surgery with NYP Hudson Valley Hospital and Associate Professor of Surgery at New York Medical College, along with Maddalena P. Duarte, MD, DABR, Medical Director of Women’s Imaging at NewYork-Presbyterian Hudson Valley Hospital. Practicing personalized medicine, together, the physicians review an MRI to determine the best course of treatment for their patient.
“In the past, the systemic therapy for advanced lung cancer was mainly chemotherapy, but during the past 10 years or so, there have been tremendous developments in the areas of targeted therapy and, more recently, immunotherapy,” Dr. Stoopler says. “We now have several oral targeted therapies we can prescribe, and because of that, we’ve started doing more sophisticated testing of tumors — a whole panel of gene-mutation testing. We’ve brought that approach to NewYork-Presbyterian Hudson Valley Hospital. Every patient at the Hospital receives the full panel of testing that’s necessary to find the mutation in the tumor, if it’s there, which allows for the administration of more targeted therapy.”
Immunotherapy for advanced lung cancer has come into its own in recent years, Dr. Stoopler says. Stage 4 lung cancer, once widely acknowledged as incurable, may now be curable for a small segment of patients.
“We can now use IV drugs to unlock the body’s immune system to fight cancer instead of attacking it directly with a toxic agent,” Dr. Stoopler says. “We’re learning to use immunotherapy drugs individually and in combination, both with each other and with chemotherapy. NYP/CUIMC is on the front line of doing this, and patients at NYP Hudson Valley are getting the most up-to-date treatments.”
Systemic treatments are just one aspect of lung cancer care at NYP Hudson Valley Hospital. A lung cancer screening program featuring low-dose CT is available to detect potentially malignant lung nodules in their early, most treatable stages. Thoracic surgeons at the hospital can perform lobectomies, which make up the majority of lung cancer surgeries; patients who require whole-lung removal are referred to NYP/CUIMC. NYP Hudson Valley also features a variety of radiotherapy modalities for patients who require it as part of their treatment.
Nationally Recognized Care for Breast Cancer
Working closely with the team from the NewYork-Presbyterian Hudson Valley Hospital Cheryl R. Lindenbaum Comprehensive Cancer Center are the surgical oncologists with the Ashikari Breast Center. Accredited by the National Accreditation Program for Breast Centers (NAPBC), the Ashikari Breast Center at NYP Hudson Valley Hospital is a comprehensive destination for breast cancer care in the region. The design of the cancer center allows for efficiencies that are often not possible at major breast centers, according to Dr. Oster, Associate Professor of Medicine at Columbia and an attending physician at NYP/CUIMC.
Dr. Mears examines a patient in the NYP Hudson Valley Hospital Cheryl R. Lindenbaum Comprehensive Cancer Center.
“When patients have screening mammograms at the NYP Hudson Valley Hospital Diagnostic Imaging Center, the surgical oncologists who are located on-site can biopsy and review suspicious findings almost instantaneously,” Dr. Oster says. “If a sample is malignant, patients need only walk to a nearby office in the building to meet with a surgeon or see a medical oncologist or radiation oncologist. It’s a quick, efficient and reassuring way to address abnormalities.”
Clinicians no longer regard breast cancer as monolithic, preferring instead to think of it in terms of several disease types, according to Dr. Oster. Each type requires a different, often multimodal approach to treatment.
“For some types, we recommend surgery first, possibly followed by chemotherapy or hormonal therapy, and for others, chemotherapy followed by surgery,” Dr. Oster says. “For HER2-positive breast cancer, for example, we recommend targeted therapy aimed at the HER2 substance on the cancer cells in conjunction with chemotherapy administered prior to surgery. That approach has produced excellent results, and it’s an example of how a combined approach featuring medical oncology, surgery and radiotherapy, which is often used after lumpectomy, can maximize chances of cure.”
HER2-positive breast cancer is an area in which researchers have made significant strides in developing new treatment agents, according to Dr. Oster. Those advances are reflected in the availability of leading-edge therapies at NYP Hudson Valley.
“Not that long ago, HER2-positive was considered the worst form of breast cancer from the standpoint of prognosis, but we’ve gradually developed more and more agents that target the HER2 substance,” Dr. Oster says. “We have trastuzumab and pertuzumab to use as neoadjuvant therapy (before surgery), and adjuvant therapy (after surgery) and neratinib, an oral drug that can be used to give extended therapy after surgery. HER2-positive now has probably the most favorable prognosis of any breast cancer in terms of cure rate.”
Hormone therapy for breast cancer has also come a long way in recent years, allowing medical oncologists to eschew the use of chemotherapy for tumors that have estrogen or progesterone receptors on their cells, according to Dr. Oster. The development and FDA approval of a group of oral drugs called CDK inhibitors to be used with hormone treatments has eliminated the need for IV chemotherapy in a significant number of breast cancer cases.
“With CDK inhibitors, we’re seeing results that are at least as positive as those of chemotherapy,” he says. “The side effects caused by CDK inhibitors are much milder.”
“When I came to NewYork-Presbyterian Hudson Valley Hospital, I’d never practiced at a small, community hospital, only at major medical centers. Right away, I noticed the hospital’s warmth, friendliness and compassion, which is wonderful for patients who are dealing with the challenges of cancer treatment. It was a very appealing change for me.”
— Martin Oster, MD, medical oncologist at NYP Hudson Valley Hospital, Associate Professor of Medicine at Columbia and attending physician at NYP/Columbia University Irving Medical Center
At the Forefront of Blood Cancer Treatment
Many of the precision therapies that are transforming how clinicians approach the treatment of various cancers emerged from the field of blood and bone marrow cancer, according to Dr. Mears, a specialist in such cancers and Professor of Medicine at Columbia and attending physician at NYP/CUIMC. This is especially true of immunotherapies.
(From left) Dr. Ashikari, surgical oncologist, Leah Katz, MD, MPH, radiation oncologist with NYP Hudson Valley Hospital, Dr. Oster and Lawrence Koutcher, MD, Medical Director of Radiation Oncology, NYP Hudson Valley Hospital. This team works closely together to ensure every patient has a comprehensive treatment plan that is based on expertise, collaboration and compassion and sets the patient’s mind at ease with team-based complex decision-making and advance planning.
“The first monoclonal antibody was Rituxan for lymphoma, and now there are many,” Dr. Mears says. “Until recently, there was no antibody therapy for multiple myeloma and now there is. The effort to unmask and unleash the immune system by blocking the signals that many cancers release to inhibit tumor surveillance is now very active in many malignancies.”
The next step in immunotherapy, Dr. Mears says, is a type of adoptive cell transfer that transforms patients’ T cells in a laboratory to target cancer cells in diseases such as chronic lymphocytic leukemia and multiple myeloma.
“These new immunotherapies are really going to change how we manage cancer,” Dr. Mears says. “They’ll be applicable to solid tumors, but researchers just have to find the right target. We have the ability to send patients from NYP Hudson Valley Hospital to NYP/CUIMC for this type of therapy. It’s about a three-week process to remove the T cells, send them off to be re-engineered in a lab and then reintroduce them into patients. Very few centers around the country even offer this treatment to their patients.”
“If patients at NewYork-Presbyterian Hudson Valley Hospital have been through the usual standard of care to little or no effect, the only way they can access experimental agents is through a clinical trial. It’s wonderful to be able to seamlessly refer them to NYP/Columbia University Irving Medical Center for such trials and remain involved in their care throughout the process.”
— Mark B. Stoopler, MD, medical oncologist at NYP Hudson Valley Hospital, attending physician at NYP/Columbia University Irving Medical Center and Associate Professor of Medicine at Columbia
Supporting the Whole Patient
The experience of living with and receiving treatment for cancer affects myriad aspects of physical and emotional health, and its impact persists long after therapy ends. That is why NYP Hudson Valley Hospital offers a variety of services that cater to patients’ overall well-being, including:
- Personalized survivorship support
- Lymphedema therapy
- Nutrition counseling
- Palliative care
- Patient navigation
- Support groups for patients, survivors and caregivers
Dr. Katz and Dr. Koutcher provide the medical leadership to the NYP Hudson Valley Hospital Radiation Oncology Department.
One of the Hospital’s most innovative services is the Integrative Therapies Program, an initiative Dr. Mears developed to teach patients and families about the importance of a healthy lifestyle in alleviating the effects of cancer. Offered several times per year in four-week stints, the program hosts groups of patients and caregivers for weekly sessions in which Dr. Mears discusses topics such as inflammation and stress. Attendees learn about healthy lifestyle changes and non-pharmacologic coping mechanisms, including exercise, yoga and acupressure, as well as enjoy cooking demonstrations in the Hospital’s Chef Peter X. Kelly Teaching Kitchen.
“The data are quite clear that activating the body’s relaxation response does all sorts of good things physiologically,” Dr. Mears says. “Patients undergoing cancer therapy who practice meditation, yoga or deep breathing have a lower incidence of fatigue and fewer side effects, and they recover more quickly from the interventions they have.”
The Integrative Therapies Program exemplifies the type of person-centered care that fuels NYP Hudson Valley Hospital’s patient-satisfaction success — its scores exceed 95 percent. The program’s reach, however, extends beyond patients, and that’s exciting to Dr. Mears.
“The Integrative Therapies Program meets everyone’s needs,” he says. “We want patients who participate to include a loved one because our focus is on prevention. If we could eliminate smoking and obesity, the incidence of cancer would be markedly lower. Integrative oncology can be preventive, which is why patients’ families should be involved.”
A Specialized Future
The future promises more cross-pollination and ever-tighter links between NYP Hudson Valley Hospital and NYP/CUIMC, as NewYork-Presbyterian works to implement a single electronic health record (EHR) across its campuses. Our plans also include the capability to offer experimental therapies not just in New York City, but at NYP Hudson Valley Hospital as well. Expanding our resources through efforts to recruit additional specialized medical oncologists from NYP/CUIMC to NYP Hudson Valley Hospital is another key area of focus.
NewYork Presbyterian Medical Group Hudson Valley medical oncologists for the NYP Hudson Valley Hospital Cheryl R. Lindenbaum Comprehensive Cancer Center walk through the Infusion Center. These physicians, experts in the field, have worked together in the Columbia University Irving Medical Center for over 30 years.
“In the future, we plan on bringing more physicians with diverse cancer expertise to NewYork-Presbyterian Hudson Valley Hospital so we can expand our coverage of all disease areas right here,” Dr. Stoopler says. “The goal is to continue to add the experts who care for each major form of cancer, which will enable us to address the unique needs of all of our patients by offering the best possible care for every type of cancer from diagnosis through survivorship.”
For more information about cancer services at NYP Hudson Valley Hospital, visit nyp.org/hudsonvalley.