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SCCA Network News, Issue 4 Fall 2009

In this issue:

H1N1 and the Oncology Patient: Insight into SCCA’s Successful Respiratory Virus Management Plan

By Sara Dreitzler, RN, Infection Control Coordinator, SCCA
Respiratory virus infections are a cause of significant morbidity and mortality among patients undergoing cancer care. In this patient population, respiratory viruses have a higher tendency to progress to severe lower respiratory tract infections. Influenza, in particular, can have deleterious outcomes for immunocompromised people. Vigorous infection control policies that address prevention of respiratory viruses for inpatient and outpatient oncology centers are essential in order to provide safe patient care.

  • A year prior to the recognition of H1N1 (swine) influenza, Seattle Cancer Care Alliance (SCCA) had implemented a comprehensive respiratory virus management plan that included:
  • Symptom screening during check-in
  • Strict infection control measures including a stringent staff sick leave policy
  • Enhanced Surveillance

This plan was well in effect when H1N1 (swine) influenza was first detected in April 2009. Remarkably, we did not see an increase in influenza rates throughout the pandemic. SCCA’s low influenza rates may be attributed to maintaining the respiratory virus management plan through the entirety of the pandemic.

Valuable Lessons Learned

There have been many valuable lessons learned during the planning and implementation of such a robust respiratory virus prevention program in a clinic setting, all of which are applicable to H1N1 (swine) influenza preparation.
First and foremost, leadership must be involved as advocates for the program in the early stages of planning. The sooner and more involved, the more likely your program will be well-received by staff, thus improving its effectiveness as a prevention program.

Secondly, surveillance systems must be designed to be highly sensitive in detecting new cases and should not be dependent upon receipt of a lab test result as this can delay case identification for up to three days. In order to be truly effective, isolation must be implemented at the onset of symptoms. At the SCCA clinic, this was accomplished by instituting symptom screening stations at each patient check-in point.

Thirdly and possibly the most challenging component of our plan was the staff sick policy. We required staff with any symptoms consistent with the cold or flu to stay home until completely asymptomatic. This was a monumental culture shift for our staff since those in the medical field tend to possess a strong work ethic. Leadership and human resources support was crucial in order to implement this piece successfully.

Lastly, we realized that we needed to embed flexibility into our plan as different scenarios require different levels of response. For this we consulted with the World Health Organization’s pandemic response plan and developed our own threshold definitions based upon our patient population and community. With many lessons learned, we found the final product to be a workable plan that is well-utilized by staff, giving us the practice we need to respond to respiratory virus pandemics efficiently to ultimately protect our patients and staff.

VATS for Lung Cancer Surgery

Thoracoscopic lobectomy has evolved dramatically since its introduction more than 15 years ago. Originally, Video Assisted Thoracic Surgery (VATS) was an approach that complemented or enhanced conventional open surgical approaches. Large incisions were downsized a bit but ribs were still spread and cameras were used mainly to enhance visualization through these slightly more limited exposures. The early operations did not adhere to basic oncologic surgical principles and often lung tissue, vessels, and airways were mass ligated.

Later iterations of VATS lobectomy sought to precisely recapitulate the dissection sequence and approach used with conventional open surgery. This did not translate well. The operations were excessively long and patients experienced prolonged post-operative air leaks that extended their stays in the hospital. Currently an “anterior to posterior” dissection sequence is employed with VATS lobectomy. It is entirely anatomic and oncologically sound. It is foreign to many non-VATS surgeons however, likely adding to their reluctance to adopt it into their practices.

Despite criticism from those that do not perform VATS lobectomy, the medical literature now confirms its efficacy and benefits. The adequacy of resection, number of lymph nodes resected, and cancer-specific survival are at least as good as that seen with conventional open surgery. It is readily taught and is quite safe with reported complication rates that appear to be lower than those seen with open surgery. This may be particularly true for frail patients who might be overwhelmed by an open approach.

In addition, patients who have VATS have been shown to experience less pain, less of an inflammatory response, shorter duration of chest tube drainage and hospital stay, and better tolerance for adjuvant chemotherapy when indicated.

The keys to experiencing the benefits of VATS lobectomy are careful patient selection and precise performance of the appropriate techniques by an experienced VATS surgeon.

For more information, go to www.seattlecca.org/VATS or contact patient care coordinator Margaret O’Connor at (206) 598-1980 or Fax (206) 598-6608.

Dr. Mulligan is Director of Minimally Invasive Thoracic Surgery at University of Washington Medical Center and is available for consultation by calling (206) 598-1980.

SCCA Physician Profile: Michael Mulligan, MD

Director of Minimally Invasive Thoracic Surgery Director of Minimally Invasive Thoracic Surgery UW Medical Center

Dr. Michael Mulligan is the director of Minimally Invasive Thoracic Surgery at University of Washington Medical Center and regularly performs and teaches video-assisted thoracic surgery (VATS). A leader in the Pacific Northwest for cardiothoracic surgery, he has performed hundreds of lung transplants and thousands of other thoracic surgeries.

At SCCA, Dr. Mulligan specializes in treating patients with lung cancer, mesothelioma, and chest sarcoma. He has been featured on the Patient Power radio show to discuss VATS (June 4, 2008) and lung cancer research and new treatments (November 19, 2006).

Dr. Mulligan is a UW associate professor in cardiothoracic surgery. He has earned numerous teaching and research awards and is among the youngest members ever elected to the American Surgical Association.

SCCA Physician Profile: Jennifer Specht, MD

Medical Oncologist

Dr. Jennifer Specht is a medical oncologist at SCCA. She received her medical and fellowship training at University of Washington School of Medicine and Fred Hutchinson Cancer Research Center. She is an assistant professor at UW in the Medical Oncology division and specializes in treating breast cancer.

“As our scientific understanding of breast cancer advances, treatment options for patients become increasingly complex,” Dr. Specht says. “As a medical oncologist, my role is to provide patients with state-of-the-art recommendations for their treatment; integrating the best science with the unique needs of each patient. I support patient participation in well-designed clinical trials to answer important scientific questions about breast cancer, which ultimately leads to better health and longer life for cancer patients.”

Overlake Hospital Medical Center

For nearly 50 years, Overlake Hospital Medical Center has provided Eastside residents with exceptional medical care. Overlake is a 337-bed, non-profit regional medical center that receives no public financing or taxpayer support. Overlake relies on generous donations from the community to provide its life-saving work.
Distinguished for its cardiac, surgical, cancer, and women’s services, the hospital treats more than 220,000 outpatients and 21,000 inpatients each year, while welcoming more than 4,000 babies into the world. In addition, Overlake is the only Level III trauma center serving east King County.

The Cancer Center at Overlake offers world-class cancer care to more than 1,100 analytic cancer cases annually. Advanced diagnostics aid in early detection and a multidisciplinary approach to treatment brings together collaborative patient care teams to develop individually tailored treatment plans. Overlake provides advanced radiation therapy technologies including image-guided radiation-therapy (IGRT) and in January 2009 will begin offering Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SRT). If patients require hospitalization, Overlake’s designated inpatient oncology unit delivers specialized cancer care in a comfortable, homelike environment. The Breast Health Center offers digital mammography screening in Bellevue and Issaquah, and Overlake’s hospital-based breast health specialists include dedicated breast surgeons and breast radiologists.

In the summer of 2009 Overlake became a Seattle Cancer Care Alliance Network Member and is currently offering three SCCA Network clinical trials on the Overlake campus.

Physician Profile: Tanya Wahl, MD

Oncology Research Medical Director, Overlake Hospital Medical Center

Dr. Tanya Wahl has been with Overlake Hospital Medical Center for six years. She enjoys the challenges of caring for patients with any type of cancer but she has a special interest in breast cancer and clinical research. She earned her medical degree at Duke University School of Medicine and did her internship, residency, and chief residency at Stanford University School of Medicine. In addition, Dr. Wahl did a fellowship in Hematology at the University of Washington/Fred Hutchinson Cancer Research Center and is board certified in Internal Medicine and Oncology.

As Overlake’s Oncology Research Medical Director, she oversees the oncology trial selection process, serves as an advocate for oncology research and liaises with SCCA.
“Clinical research trials have become increasingly important at Overlake, and our new affiliation with the Network gives patients even better access to a wide range of trials,” she says.

Dr. Wahl was recently awarded the Cancer Liaison Physician Outstanding Performance Award by the American College of Surgeons (ACoS) Commission on Cancer (CoC) for her work in advancing clinical research.

Sea Mar Community Health Centers

Sea Mar Community Health Centers is one of Washington’s largest community health-care provider to Latino patients with locations along the I-5 corridor from as far south as Vancouver to as far north as the Canadian border. They have become the first outreach affiliate of the Seattle Cancer Care Alliance Network.

This new relationship will bring a variety of services, including cancer prevention and screening education, treatment referral, and physician education to Sea Mar health-care providers and their patients. A key benefit of this relationship will be better continuity of care for Sea Mar patients who choose to be treated at SCCA.

“We are extremely excited to have a relationship with the largest community health provider for the Spanish-speaking population in the Pacific Northwest,” said Norm Hubbard, SCCA Executive Vice President.

Sea Mar began in 1978 with one small clinic in the South Park neighborhood of Seattle. Today, Sea Mar is one of the largest providers of health and human services.
“We are very pleased to offer state-of-the-art oncology care to those patients served by Sea Mar,” said Marc Stewart, MD, SCCA Medical Director. “We look forward to partnering with physicians at Sea Mar to deliver seamless services to our Spanish speaking community.”

Physician Profile: Ricardo Jimenez, MD

Medical Director, Sea Mar Community Health Centers

Dr. Ricardo Jimenez is the Medical Director of Sea Mar Community Health Centers, and oversees 18 medical clinics throughout Washington State.

He received his medical education and degree from the University of Trujillo Medical School in Trujillo Peru. In 1983, Dr. Jimenez came to the United States for family medicine training. He received residency and faculty development fellowship training at Cook County Hospital in Chicago in Family Medicine. In 1990, Dr. Jimenez began caring for low-income patients at Sea Mar and became their medical director in 1995.
In addition to providing direct patient care, Dr. Jimenez spends time lecturing and precepting residents and medical students in the clinic and hospital. He also runs an international exchange program that provides learning opportunities for medical students and residents from the U.S. and developing countries.

“The partnership between Sea Mar and SCCA is a desirable cooperative affiliation that greatly benefits our patients in their cancer care needs,” Dr. Jimenez says. “It is a point where comprehensive cancer care meets the community.”

Oncology Physician Liaison Joins SCCA Team

In our efforts to enhance the SCCA/UW referral system and collegial physician communications with SCCA Network providers, we are pleased to announce the hiring of a dedicated Oncology Physician Liaison, Autumn Mumaw, to facilitate access and physician communication issues between SCCA, UW Medical Center (UWMC), and referring providers.

Autumn brings with her a passion for customer service and operational performance improvements that will support strong continuity of patient care. Her professional career accomplishments include working in collaborative ways with clinical care teams, increasing patient and referring physician satisfaction, and implementing innovative training and triage approaches to support growth goals. She received her Bachelors degree in Community Health Education from Western Washington University and most recently worked for Seattle Cancer Care Alliance in their Patient Intake Office.
In her new role as Oncology Physician Liaison, Autumn will assist in facilitating access of oncology (diagnosed) and potential oncology (undiagnosed) patients into the SCCA/UWMC care system.

Autumn may be reached at (206) 598-5897 or by email at amumaw@u.washington.edu if you experience any of the potential access issues listed below:

  • The appropriate oncology service or provider is unclear
  • You need assistance with facilitating undiagnosed or unknown primary cancer patients into the SCCA/UWMC system
  • The patient or provider has not been contacted within a reasonable time
  • Any “hot issues” related to oncology patient referrals or access.

Patient Referral Form Improvements

Several additions have been made to the Confidential Patient Referral Form in order to improve the referral process for Network Physicians.

  • A section to specify a specialty consult was added.
  • A section to indicate if a patient is being referred for a clinical trial was added.
  • A signature line for the referring physician was added.

Network in the Community

The Denali Oncology Group (DOG) Conference is held annually for oncology practicing physicians throughout Alaska. Experts from major cancer centers in the United States are invited as guest speakers. Conference locations vary each every year. This year’s conference took place in Valdez, Alaska from July 22nd through the 24th.

The 2009 DOG Conference included physicians from SCCA and UW Medical Center to speak on select oncology topics, including Anthony Back, MD on palliative care; Eli Estey, MD on AML; and James Douglas, MD on radiation oncology. In addition to the speakers, Ben Greer, MD and Cecilia Zapata from the SCCA Network also attended the conference.

Plans for a 2010 conference, which is being organized by John Halligan, MD, are well under way. We look forward to being a part of this important meeting once again.

The 6th Annual Skagit Valley Hospital Par Tee Golf Classic event on July 10th, raised $32,700 to benefit Skagit Valley Hospital’s Cancer Care Patient Assistance fund.
Nearly 150 golfers played at the Eaglemont Golf Course in Mount Vernon, including Geoff Austin, Oncology Service Line Administrator, George Laramore, MD, Chairman of the UW Department of Radiation Oncology, and Lisa Lim from the SCCA Network. The golfers were treated to continental breakfast, dinner, putting contests, use of golf carts, and activities and refreshments at each hole. Other features included hole-in-one prizes, a raffle and many give-aways.