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DECEmBER 2014 | ISSUE 11

8

News from the Hartford HealthCare Cancer Institute

Rendering optionsHHCI andMemorial Sloan Kettering Cancer Alliance Member1/25/2014

A

B

MEMBER

Donna Handley

Vice President of Operations, Hartford HealthCare CancerInstitute

The name we call ourselvesWhat’s in a name? A lot, especially when we’re

raising awareness about the Hartford HealthCare Cancer Institute and the comprehensive and coordinated cancer services we offer across Connecticut. We are proud of what we have cre-ated, and we need to identify our Institute in a consistent manner so it gains recognition.

So, I’d like to explain how and why we are now referring to ourselves across our system.

At all our cancer centers, we are now known as:The Hartford HealthCare Cancer Institute at

[name of hospital*] (*Backus Hospital, Hartford Hospital, The Hospital of Central Connecticut, MidState Medical Center, Windham Hospital)

We are working with our colleagues in the Fund Development and marketing departments across our system so that we continue to honor, in all appropriate ways, the gifts and legacies of those whose names are attached to some of our programs. These include the Helen & Harry Gray Cancer Center at Hartford Hospital and the George Bray Cancer Center at HOCC.

Therefore, in brochures, stories and other ap-proved materials, we will continue to refer to these

centers in printed copy. We also will ensure that the names of these individuals are recognized in appropriate signage within our Institute’s cancer centers.

I understand and appreciate the affinity you may have for the individual cancer centers where you work or care for patients or, in the case of patients, receive care. This sense of pride and loyalty is com-mendable. Yet, in order for people to understand what we are about and the full range of services available to them, it’s critical that we convey a broader awareness of what we have created and why the Institute model matters.

We recognize that patients at all of our cancer centers are accustomed to calling us by the names they are familiar with. Patients and providers and staff all will benefit greatly from our Cancer Institute, and in time, everyone will recognize that and call us by our name. But only if we start doing that now.

I thank you for your help.

Plus

In this issuen Disease management

Teams: The foundation for care

n Leading-edge surgical procedure for HHCCI cancer patients

n Hormone therapy helps patient overcome disease

News from the Hartford HealthCare Cancer Institute

HHCCI to begin MSK clincial trials

P atients who receive care within the Hartford HealthCare Cancer Institute (HHCCI) will have

a powerful new treatment option avail-able to them early next year when the memorial Sloan Kettering (mSK) Cancer Center opens access to select offerings from its world-renowned portfolio of clinical research trials as part of HHCCI’s membership in the mSK Cancer Alliance.

mSK, widely recognized as one of the premier cancer research centers in the world, has more than 800 research trials and protocols in progress. In November, the cancer center identi-fied the trials and protocols suitable to share with HHCCI, which is the charter member of the mSK Cancer Alliance. mSK hopes the Alliance will create a broader population of patients who can gain access to trials, while HHCCI

is taking advantage of the relationship to implement an elevated standard of care for patients.

“We are thrilled to begin the process of identifying those trials that are best suited for HHCCI’s patients,” said Paul Sabbatini, mD, mSK’s deputy physician-in-chief for clinical research. “This is not only a great opportunity for

See TRIALS, page 6

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On the coverKatherine Hsu, MD, center, an oncologist, hematologist and scientific researcher at Memorial Sloan Kettering Cancer Center, in one of MSK’s groundbreaking research centers

“Plus” checked in with Deborah Ford, manager of Facility Project Development, for an update on the new Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut. The new facility sits on a parcel of land overlook-ing Interstate 84 on the Plainville-New Britain town line.

The new cancer center will offer a full range of cancer services, as well as a medical office building for providers. It is expected to open in the spring of 2015. Construction in excess of 100,000 square feet began in January 2013.

C onstruction of the cancer center is progressing

significantly. We have completed above-ceiling inspections on both the first and second floors in the main cancer cen-ter building, and ceil-ings, lighting, flooring and millwork are being installed throughout the facility.

The medical Office Building, where both imaging ser-vices and the new Comprehensive Breast Care Center will be located, is just a few weeks from starting the same process. Work on critical sys-tems, such as the fire alarms, nurse call system, electrical system com-missioning and elevator work is also in process.

We have been working with user

groups to develop an activation cal-endar over the past months, and that process is completed. We will follow the same phasing plan for activation of the building as we did for con-struction: second-floor cancer center first, first-floor cancer center second, and finally the first floor of the medi-cal office building.

Our information systems team is

leading with installation of a com-munications network infrastructure. We expect to obtain a certificate of occupancy for the cancer center by Dec. 30 and for the medical office building by Jan. 30, 2015. We continue to target the first week of march for a licensure inspection by the state Department of Public Health, with moves to follow on their approval.

Progress continues on HOCC cancer center site

Progress continues with the construction of the new Hartford HealthCare Cancer In-stitute at The Hospital of Central Connecticut. Above, work is nearly complete on the grand fireplace/staircase that will greet visitors in the main lobby. At left, the building exterior.

Q. Can you explain what a Disease Management Team is within the context of the Hartford HealthCare Cancer Institute (HHCCI)? How are individual teams established and who takes part?

A. Dr. Hosmer. Disease management Teams (DmTs) are the structure that allows for the stan-dardization and coordination of oncology care across all sites within HHCCI. They are organized based on disease sites: thoracic, gastro-intestinal, gynecologic, breast and genitourinary. The teams have repre-sentatives that span the geographic sites within the cancer institute and are composed of physicians from various specialties, nursing staff, research staff, and the institute executive leadership. Besides myself and Dr. Fumo, other DmT physician leads are genitourinary lead Anoop meraney, mD; gynecologic team lead Jonathan Cosin, mD; and breast team lead Patricia DeFusco, mD.

Q. In your view, what are some of the main advantages of utilizing the DMT model for providing the best care for patients?

A. Dr. Fumo. The DmT model has effectively brought multiple HHCCI sites throughout the State of Connecticut together and created a rich forum for continuing education, standardization of practice and adop-tion of clinical trials.

Q. Can you describe your role as a DMT physician leader?

A. Dr. Hosmer. As the physician leader of the thoracic DmT, my role is to assist in structuring ongoing

agendas for the DmT, facilitate dis-cussions on evolving standardization of care across the institute, coordinate research priorities for thoracic ma-lignancies and provide educational opportunities for DmT members. Each DmT also has an administra-tive leader who plays a pivotal role in coordinating and carrying out the mission for each DmT. Administrative DmT leaders include Carol Barrett for the thoracic DmT; Dawn Plumb for the gastrointestinal DmT; Jan Ruderman for the genitourinary DmT; and Karen Weingrod for both the breast and gynecologic DmTs.

Q. Did HHCCI’s membership in the Memorial Sloan Kettering (MSK) Cancer Alliance have an influence on the decision to adopt a DMT model of care?

A. Dr. Fumo. The DmT model for some disease sites did exist at HHCCI prior to our relationship with mSK, but our membership in the mSK Cancer Alliance has clearly broadened

and accelerated the process. The DmT model continues to promote the goals set by the alliance. For example, the DmTs serve to channel communication between these two very large organizations while also helping to disseminate important information among the clinicians who are caring for our patients (policy to practice).

Q. Do you envision the role of DMTs expanding as the Institute continues to evolve?

A. Dr. Hosmer. I am certain that the role of the DmT will continue to expand as the institute evolves. The DmT will be the vehicle for modifying any standards of care, communicat-ing changing practices to institute members and overseeing the expand-ing research opportunities provided by the mSK Alliance.

Q. Why should referring physi-cians and patients feel confident that the DMT model will meet their needs?

A. Dr. Fumo. Every decision or pro-cess that results from the DmT model has gone through a very rigorous and thoughtful evaluation involving multiple specialty disciplines with a single goal in mind: To provide the best cancer care in our communities throughout Connecticut.

Gerard Fumo, DO, specializes in medical oncology and hematology at the Hartford HealthCare Cancer Institute at MidState Medical Center. Wylie Hosmer, MD, specializes in medical oncology at the Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut.

Disease Management Teams are the foundation for care

Q&A with

Gerard Fumo, DOGastrointestinal Oncology

Disease Management Physician Team Lead

and

Wylie Hosmer, MDThoracic Oncology Disease

Management Physician Team Lead, Hartford HealthCare

Cancer Institute

The month of November was marked by a high-profile effort across Hartford HealthCare to call attention to men’s health issues as part of the national “Movember” campaign. Male em-ployees throughout the organization were encouraged to show their support by growing beards or mustaches, including, shown here from left, Mohamed Saleh, performance improvement facilitator for Hartford HealthCare; Dr. Anoop Meraney, lead of the urologic oncology Disease Management Team for the Hartford HealthCare Cancer Institute; Dr. Gerard Fumo, lead of the gastro-intestinal oncology Disease Management Team for the Hartford HealthCare Cancer Institute; and Kris Popovitch, director of the Central Region for the Hartford HealthCare Cancer Institute.

A ‘Movember’ to remember

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us to advance our clinical trials program but to bring cutting-edge treatments directly to patients in their communities.”

A key component of this relation-ship is focused on how the Alliance will provide HHCCI patients and providers with access to mSK trials. After careful review, mSK provided HHCCI with a list of 116 trials that cover a broad range of cancer types

and stages. “We are using this list as a jumping off point, and we’re confident that the trials we open will of-fer our patients exciting new op-tions,” said Kiran

Avancha, director of cancer clinical research for HHCCI.

“There is a great deal of enthusi-asm about how these trials, com-bined with the research capabilities already in place across HHCCI, will benefit our patients in profound and meaningful ways,” Avancha added. “The research being conducted across these trials and protocols goes to the heart of our under-standing of cancer and will lead to improved outcomes for patients.”

Donna Handley, vice president of operations for HHCCI, said the Institute’s cancer research team hopes to make the first mSK trial available to patients by the middle of January. She said select trials identi-fied by mSK will be made available to providers and patients on a gradual, phased-in basis. These 116 clinical trials will undergo a thorough vet-ting process by HHCCI’s individual Disease management Teams (DmTs) to optimize the selection of trials that are ultimately offered. Then those select, DmT-approved trials will undergo human subject protec-tion and a safety review process by Institutional Review Boards (IRBs) of

both mSK and HHC.“We are going to start slowly to

make sure we have a proper system in place for administering and pro-cessing these trials,” Handley said. “There are many variables that need to be attended to such as transporta-tion and storage of these drugs, as well as determining which patients are best suited for taking part.”

Yet Handley said cancer-care physicians and providers across the Institute should be excited about

the opportunities these trials will provide them. She said the full list of trials will be shared with the entire HHCCI medical staff soon.

“From a provider standpoint, this is really the most exciting aspect of our relationship with mSK,” she said. “Instead of telling their patients they have to make a trip to New York to take part in these trials, now they will be able to tell their patients that the same trials are available in their own communities.”

TRIALS from page 1 HIPEC is making a difference in patients’ lives

T raditionally, cancers that have metastasized to the peritoneal lining of the abdo-

men have been enormously difficult to treat, with standard chemotherapy being the primary treatment op-tion. But a small handful of surgical oncologists across Connecticut — including Bret Schipper, mD, with the Hartford HealthCare Cancer Institute — are now performing a complex new procedure that enables surgeons to attack this relatively rare form of cancer with greater success

Dr. Schipper has been perform-ing the HIPEC — or hyperthermic intraperitoneal chemotherapy — procedure for the past two years, including five procedures at Hartford Hospital over the past four months. Each of those five patients has re-covered nicely from the procedure, with their cancers in remission, Dr. Schipper said.

“It’s a challenging procedure, but it can make a big difference for patients,” said Dr. Schipper, who esti-mated that most patients can expect

to see their cancers stay in remis-sion from a year to a couple of years depending on the pathology after the procedure is completed.

Patients who are candidates for the HIPEC procedure include those with primary colorectal cancer, ovarian cancer, gastric cancer or appendiceal can-cer or who have mesothelioma or peritoneal carci-nomatosis — and whose cancer has spread to the peritoneal lining in the abdomen.

The HIPEC procedure attacks such cancers through two stages: first, the surgical removal, or “debulking,” of all existing tumors in the abdomen; and second, through a complex chemo-perfusion circuit that distributes a carefully rendered chemotherapeutic agent at 41 degrees centigrade and circulates it at about 1L per minute throughout the cavity. The high

temperature and the chemotherapy work in a synergistic way to kill the cancer, Dr. Schipper said. The agent is distributed carefully for 90 minutes to give it time to kill the microscopic disease in the abdomen, he said.

In all, the procedure can take any-where from four hours to 14 hours to complete, he said. Because of the direct nature in which the chemo-therapeutic agent is distributed, patients generally suffer fewer side effects from the chemotherapy than would be seen if given systemically as classic chemotherapy, he added.

“It’s proven to be very successful,” Dr. Schipper said, while emphasizing that the procedure is available only to a small population of cancer patients. He said the procedure is not meant to be a cure, but a palliative way to give people with end-stage cancer more time to spend with their family and loved ones.

To learn more about the procedure or arrange a consultation, please contact Dr. Schipper’s office at 860-827-1981.

Bret Schipper, MD

Dr. Andrew Salner, medical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, spoke at a Nov. 13 business summit focusing on the future of bioscience and opportu-nities in the Greater Hartford Region, sponsored by the Farmington Chamber of Commerce. Dr. Salner spoke about the Hartford HealthCare Cancer Institute’s membership in the Memorial Sloan Kettering Cancer Alliance and how it will help bring the latest advances in treatment and technology to patients throughout the region.

Further consideration

n What is a clinical trial?A clinical trial is a type of clinical research study that tests a new

medical approach in people to make sure it is safe and effective. A clinical trial is sometimes called a research protocol, a clinical study or simply medical research.

Clinical trials can cover a broad range of subjects. Some clinical trials study a drug, a medical device or a new way of doing surgery. Others test new ways to prevent disease, diagnose disease, improve quality of life, or help people with diseases such as cancer manage difficult psychological and social issues. Some clinical trials are small, with just a few patients. Others are large and involve thousands of patients at large research centers.

Clinical trials have played an important role in the fight against cancer and other diseases. They are the only scientific way to prove whether a new treatment works better than current treatments. most of the approaches that doctors use to treat cancer today would never have become available without clinical trials.

n What is an Institutional Review Board (IRB)?Under U.S. Federal Drug Administration regulations, an IRB is an

appropriately constituted group that has been formally designated to review and monitor biomedical research involving human subjects. In accordance with FDA regulations, an IRB has the authority to approve, require modifications in (to secure approval) or disapprove research. This group review serves an important role in the protection of the rights and welfare of human research subjects.

The purpose of IRB review is to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in the research. To accomplish this purpose, IRBs use a group process to review research protocols and related materials (e.g., informed consent documents and investigator brochures) to ensure protection of the rights and welfare of human subjects of research.

Kiran Avancha, PhD

An exciting future

The cancer programs at The Hospital of Central Connecticut (HOCC) in New Britain and MidState Medical Center in Meriden, both part of the Hartford HealthCare Cancer Institute (HHCCI), are partnering with the Southington YMCA to provide post-cancer treatment services to patients through the Y’s Livestrong program. Shown here are, from left, Linda Prus, health and wellness program coordinator for the Southington Y; John Myers, executive director of the Southington Y; Noa Mencher, RN, HOCC nurse navigator; and Kristoffer Popovitch, director of the Central Region for HHCCI. For more information, please go to www.thocc.org/cancer or www.midstatemedical.org/cancer.

HHCCI partners with the Southington YMCA

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A manda Hadder, a 31-year- old mother from New Britain, weighed almost

400 pounds when she experienced an unusual amount of blood loss during her menstrual period last year, prompting her to visit her gynecologist. An endometrial biopsy confirmed the presence of uterine cancer.

Amanda’s doctor referred her to Dr. Jonathan Cosin, a gyneco-logic oncologist at The Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut, who told her she could proceed with either a hysterectomy or with hormone therapy. An mRI showed the cancer to be confined within her uterus so she elected to try the hormone therapy.

Amanda also learned that her weight was a contributing factor in her cancer diagnosis, so she decided to pursue a lifestyle with a greater emphasis on diet and exercise. To treat the cancer, she began a course

of progesterone pills and another medication called metformin. metformin is used to treat diabetes, which Amanda doesn’t have but has been shown in recent studies to be effective in treating some can-cers. After three months, Amanda underwent another biopsy and this time also had a mirena intra-uterine device placed. The device, which re-leases progesterone directly into the uterine cavity, helped cause com-plete regression of Amanda’s cancer within three months.

Concerned that her weight would continue to impact her health, Amanda worked hard to lose weight. Nine months after she was first di-agnosed, she has lost 165 pounds — a remarkable achievement consid-ering that one of the side effects of progesterone therapy is weight gain. She said the therapy has given her renewed energy and strength, as well as hope.

“I just feel so grateful to Dr. Cosin for treating with such compassion

and respect,” she said. “He always put me at ease and never made me feel like I was being judged, and I can’t tell you what that has done for me.” Amanda said the treatment is not expected to impact her ability to have more children in the future, and she is continuing a regimen of improved diet and exercise to regu-late her weight.

M ore than 100 patients, former patients and caregivers turned out to

learn about the latest advances in brain tumor research and treatment as part of the eighth annual Fred Cohen Symposium, hosted by the Hartford HealthCare Cancer Institute at Hartford Hospital.

The Nov. 7 event, titled “Living with a Brain Tumor: Tools to Empower Patients and Caregivers,” featured presentations from an array of experts in the field, with a key-note address by Thomas J. Kaley, mD, the director of the Neuro-Oncology Fellowship Program at memorial Sloan Kettering (mSK) Cancer Center. Dr. Kaley’s presentation, called “more Science, Less Fear,” focused on recent advances in therapies and re-search that are making great strides in successfully treating brain tumor development and growth.

“There are a lot of incredible things happening in this field, not just for the future but right now,” Kaley said.

Also presenting at the sympo-sium were Beth Taylor, PhD, director

of exercise physiology research at Hartford Hospital, who discussed the benefits of steady exercise in pre-venting brain tumors and maintain-ing a good quality of life for those living with tumors. She was followed by Eric Secor, PhD, director of the Department of Integrated medicine at Hartford Hospital, who discussed the many techniques available for reducing stress, which can contrib-ute to the growth or development of tumors.

The benefits of healthy eating,

and the pros and cons of vari-ous so-called “cancer diets,” were discussed by Liz Churchill, RDN, CDN, clinical dietician and oncology specialist at Hartford Hospital, who outlined the research and theories behind various diets, including the ketogenic diet and the alkaline ash diet.

The symposium also featured edu-cational materials and presentations offered by the American Brain Tumor Association and the Connecticut Brain Tumor Alliance.

In November, the Centers for Medicare and Medicaid Services decided

to approve a pro-posal to cover costs for all Medicare patients who are eligible for low-dose CT scan lung cancer screenings.

The screen-ings, which have been implemented across the Hartford HealthCare Cancer

Institute and other cancer programs across the country, are expected to save as many as 20,000 lives across the

United States by detecting lung cancer in its earlier stages.

Since HHCCI adopted screenings more than a year ago, nearly 800 people have been screened and at least seven have been confirmed to have early stage lung cancer.

“Plus” asked Andrew Salner, MD, medical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, to share his thoughts on the decision to extend coverage to Medicare patients:

T he decision by the Centers for medicare and medicaid

Services is based in large part

on findings in the National Lung Screening Trial (NLST), which dem-onstrated an approximate 20 percent lung-cancer mortality reduction in those screened with low-dose chest CT scan. These are people at highest risk — 55 to 80 years old with a his-tory of smoking an average of a pack of cigarettes per day for 30 years or more. In this study, 70 percent of those diagnosed had early-stage lung cancer. Using chest X-rays and look-ing at historic findings, 70 percent of newly diagnosed patients had advanced disease.

Since the fall of 2013, all of the cancer centers within the Hartford

Low-dose CT cancer screenings already having an impact by identifying at-risk patients sooner

Hormonal therapy helps patient overcome cancer and lose weight

Annual brain tumor conference draws crowd

HealthCare Cancer Institute (HHCCI) have participated in lung-cancer screening research free of charge to those who fit the criteria. HHCCI is reviewing the feasibil-ity of a community screening program in which primary care providers would refer patients who are in this high-risk popula-tion. We especially hope to reach underserved popula-tions through this program.

A standardized system of scan interpretation has been utilized by

the radiologists at our hospitals. So far, nearly 800 patients participated in this research, and preliminary

results mirror NLST findings and demon-strate feasibility. Our research will continue through 2015.

The U.S. Prevent-ative Services Task Force has given the recommendation of lung cancer low-dose

CT scan screening in high-risk popu-lations a Grade B finding, which will result in commercial insurance cov-erage of screenings starting in 2015.

The recent action of CmS to simi-larly approve coverage is reassuring to smokers, former smokers and their providers. This potentially life-saving technique will be available to those who are eligible and will save lives through early detection of lung cancer, a disease which has a high mortality rate when detected in advanced stages.

The Hartford HealthCare Cancer Institute has been at the vanguard of this technology and has supported this program throughout the com-munities it serves with a research effort which will add meaningful findings to the scientific community.

Andrew Salner, MD

Holly Cohen, wife of Fred Cohen, in whose memory the symposium is named, welcomes attendees to the eighth annual Fred Cohen Symposium in November.

To learn moren Call 860-972-LUNG (5864) for further information about the lung screening study or HHCCI smoking cessation program.

Patient Amanda Hadder, left, with Jonathan Cosin, MD, her gynecologic oncologist.

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A manda Hadder, a 31-year- old mother from New Britain, weighed almost

400 pounds when she experienced an unusual amount of blood loss during her menstrual period last year, prompting her to visit her gynecologist. An endometrial biopsy confirmed the presence of uterine cancer.

Amanda’s doctor referred her to Dr. Jonathan Cosin, a gyneco-logic oncologist at The Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut, who told her she could proceed with either a hysterectomy or with hormone therapy. An mRI showed the cancer to be confined within her uterus so she elected to try the hormone therapy.

Amanda also learned that her weight was a contributing factor in her cancer diagnosis, so she decided to pursue a lifestyle with a greater emphasis on diet and exercise. To treat the cancer, she began a course

of progesterone pills and another medication called metformin. metformin is used to treat diabetes, which Amanda doesn’t have but has been shown in recent studies to be effective in treating some can-cers. After three months, Amanda underwent another biopsy and this time also had a mirena intra-uterine device placed. The device, which re-leases progesterone directly into the uterine cavity, helped cause com-plete regression of Amanda’s cancer within three months.

Concerned that her weight would continue to impact her health, Amanda worked hard to lose weight. Nine months after she was first di-agnosed, she has lost 165 pounds — a remarkable achievement consid-ering that one of the side effects of progesterone therapy is weight gain. She said the therapy has given her renewed energy and strength, as well as hope.

“I just feel so grateful to Dr. Cosin for treating with such compassion

and respect,” she said. “He always put me at ease and never made me feel like I was being judged, and I can’t tell you what that has done for me.” Amanda said the treatment is not expected to impact her ability to have more children in the future, and she is continuing a regimen of improved diet and exercise to regu-late her weight.

M ore than 100 patients, former patients and caregivers turned out to

learn about the latest advances in brain tumor research and treatment as part of the eighth annual Fred Cohen Symposium, hosted by the Hartford HealthCare Cancer Institute at Hartford Hospital.

The Nov. 7 event, titled “Living with a Brain Tumor: Tools to Empower Patients and Caregivers,” featured presentations from an array of experts in the field, with a key-note address by Thomas J. Kaley, mD, the director of the Neuro-Oncology Fellowship Program at memorial Sloan Kettering (mSK) Cancer Center. Dr. Kaley’s presentation, called “more Science, Less Fear,” focused on recent advances in therapies and re-search that are making great strides in successfully treating brain tumor development and growth.

“There are a lot of incredible things happening in this field, not just for the future but right now,” Kaley said.

Also presenting at the sympo-sium were Beth Taylor, PhD, director

of exercise physiology research at Hartford Hospital, who discussed the benefits of steady exercise in pre-venting brain tumors and maintain-ing a good quality of life for those living with tumors. She was followed by Eric Secor, PhD, director of the Department of Integrated medicine at Hartford Hospital, who discussed the many techniques available for reducing stress, which can contrib-ute to the growth or development of tumors.

The benefits of healthy eating,

and the pros and cons of vari-ous so-called “cancer diets,” were discussed by Liz Churchill, RDN, CDN, clinical dietician and oncology specialist at Hartford Hospital, who outlined the research and theories behind various diets, including the ketogenic diet and the alkaline ash diet.

The symposium also featured edu-cational materials and presentations offered by the American Brain Tumor Association and the Connecticut Brain Tumor Alliance.

In November, the Centers for Medicare and Medicaid Services decided

to approve a pro-posal to cover costs for all Medicare patients who are eligible for low-dose CT scan lung cancer screenings.

The screen-ings, which have been implemented across the Hartford HealthCare Cancer

Institute and other cancer programs across the country, are expected to save as many as 20,000 lives across the

United States by detecting lung cancer in its earlier stages.

Since HHCCI adopted screenings more than a year ago, nearly 800 people have been screened and at least seven have been confirmed to have early stage lung cancer.

“Plus” asked Andrew Salner, MD, medical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, to share his thoughts on the decision to extend coverage to Medicare patients:

T he decision by the Centers for medicare and medicaid

Services is based in large part

on findings in the National Lung Screening Trial (NLST), which dem-onstrated an approximate 20 percent lung-cancer mortality reduction in those screened with low-dose chest CT scan. These are people at highest risk — 55 to 80 years old with a his-tory of smoking an average of a pack of cigarettes per day for 30 years or more. In this study, 70 percent of those diagnosed had early-stage lung cancer. Using chest X-rays and look-ing at historic findings, 70 percent of newly diagnosed patients had advanced disease.

Since the fall of 2013, all of the cancer centers within the Hartford

Low-dose CT cancer screenings already having an impact by identifying at-risk patients sooner

Hormonal therapy helps patient overcome cancer and lose weight

Annual brain tumor conference draws crowd

HealthCare Cancer Institute (HHCCI) have participated in lung-cancer screening research free of charge to those who fit the criteria. HHCCI is reviewing the feasibil-ity of a community screening program in which primary care providers would refer patients who are in this high-risk popula-tion. We especially hope to reach underserved popula-tions through this program.

A standardized system of scan interpretation has been utilized by

the radiologists at our hospitals. So far, nearly 800 patients participated in this research, and preliminary

results mirror NLST findings and demon-strate feasibility. Our research will continue through 2015.

The U.S. Prevent-ative Services Task Force has given the recommendation of lung cancer low-dose

CT scan screening in high-risk popu-lations a Grade B finding, which will result in commercial insurance cov-erage of screenings starting in 2015.

The recent action of CmS to simi-larly approve coverage is reassuring to smokers, former smokers and their providers. This potentially life-saving technique will be available to those who are eligible and will save lives through early detection of lung cancer, a disease which has a high mortality rate when detected in advanced stages.

The Hartford HealthCare Cancer Institute has been at the vanguard of this technology and has supported this program throughout the com-munities it serves with a research effort which will add meaningful findings to the scientific community.

Andrew Salner, MD

Holly Cohen, wife of Fred Cohen, in whose memory the symposium is named, welcomes attendees to the eighth annual Fred Cohen Symposium in November.

To learn moren Call 860-972-LUNG (5864) for further information about the lung screening study or HHCCI smoking cessation program.

Patient Amanda Hadder, left, with Jonathan Cosin, MD, her gynecologic oncologist.

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us to advance our clinical trials program but to bring cutting-edge treatments directly to patients in their communities.”

A key component of this relation-ship is focused on how the Alliance will provide HHCCI patients and providers with access to MSK trials. After careful review, MSK provided HHCCI with a list of 116 trials that cover a broad range of cancer types

and stages. “We are using this list as a jumping off point, and we’re confident that the trials we open will of-fer our patients exciting new op-tions,” said Kiran

Avancha, director of cancer clinical research for HHCCI.

“There is a great deal of enthusi-asm about how these trials, com-bined with the research capabilities already in place across HHCCI, will benefit our patients in profound and meaningful ways,” Avancha added. “The research being conducted across these trials and protocols goes to the heart of our under-standing of cancer and will lead to improved outcomes for patients.”

Donna Handley, vice president of operations for HHCCI, said the Institute’s cancer research team hopes to make the first MSK trial available to patients by the middle of January. She said select trials identi-fied by MSK will be made available to providers and patients on a gradual, phased-in basis. These 116 clinical trials will undergo a thorough vet-ting process by HHCCI’s individual Disease Management Teams (DMTs) to optimize the selection of trials that are ultimately offered. Then those select, DMT-approved trials will undergo human subject protec-tion and a safety review process by Institutional Review Boards (IRBs) of

both MSK and HHC.“We are going to start slowly to

make sure we have a proper system in place for administering and pro-cessing these trials,” Handley said. “There are many variables that need to be attended to such as transporta-tion and storage of these drugs, as well as determining which patients are best suited for taking part.”

Yet Handley said cancer-care physicians and providers across the Institute should be excited about

the opportunities these trials will provide them. She said the full list of trials will be shared with the entire HHCCI medical staff soon.

“From a provider standpoint, this is really the most exciting aspect of our relationship with MSK,” she said. “Instead of telling their patients they have to make a trip to New York to take part in these trials, now they will be able to tell their patients that the same trials are available in their own communities.”

TRIALS from page 1 HIPEC is making a difference in patients’ lives

T raditionally, cancers that have metastasized to the peritoneal lining of the abdo-

men have been enormously difficult to treat, with standard chemotherapy being the primary treatment op-tion. But a small handful of surgical oncologists across Connecticut — including Bret Schipper, MD, with the Hartford HealthCare Cancer Institute — are now performing a complex new procedure that enables surgeons to attack this relatively rare form of cancer with greater success

Dr. Schipper has been perform-ing the HIPEC — or hyperthermic intraperitoneal chemotherapy — procedure for the past two years, including five procedures at Hartford Hospital over the past four months. Each of those five patients has re-covered nicely from the procedure, with their cancers in remission, Dr. Schipper said.

“It’s a challenging procedure, but it can make a big difference for patients,” said Dr. Schipper, who esti-mated that most patients can expect

to see their cancers stay in remis-sion from a year to a couple of years depending on the pathology after the procedure is completed.

Patients who are candidates for the HIPEC procedure include those with primary colorectal cancer, ovarian cancer, gastric cancer or appendiceal can-cer or who have mesothelioma or peritoneal carci-nomatosis — and whose cancer has spread to the peritoneal lining in the abdomen.

The HIPEC procedure attacks such cancers through two stages: first, the surgical removal, or “debulking,” of all existing tumors in the abdomen; and second, through a complex chemo-perfusion circuit that distributes a carefully rendered chemotherapeutic agent at 41 degrees centigrade and circulates it at about 1L per minute throughout the cavity. The high

temperature and the chemotherapy work in a synergistic way to kill the cancer, Dr. Schipper said. The agent is distributed carefully for 90 minutes to give it time to kill the microscopic disease in the abdomen, he said.

In all, the procedure can take any-where from four hours to 14 hours to complete, he said. Because of the direct nature in which the chemo-therapeutic agent is distributed, patients generally suffer fewer side effects from the chemotherapy than would be seen if given systemically as classic chemotherapy, he added.

“It’s proven to be very successful,” Dr. Schipper said, while emphasizing that the procedure is available only to a small population of cancer patients. He said the procedure is not meant to be a cure, but a palliative way to give people with end-stage cancer more time to spend with their family and loved ones.

To learn more about the procedure or arrange a consultation, please contact Dr. Schipper’s office at 860-827-1981.

Bret Schipper, MD

Dr. Andrew Salner, medical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, spoke at a Nov. 13 business summit focusing on the future of bioscience and opportu-nities in the Greater Hartford Region, sponsored by the Farmington Chamber of Commerce. Dr. Salner spoke about the Hartford HealthCare Cancer Institute’s membership in the Memorial Sloan Kettering Cancer Alliance and how it will help bring the latest advances in treatment and technology to patients throughout the region.

Clinical trials, IRBs explained

n What is a clinical trial?A clinical trial is a type of clinical research study that tests a new

medical approach in people to make sure it is safe and effective. A clinical trial is sometimes called a research protocol, a clinical study or simply medical research.

Clinical trials can cover a broad range of subjects. Some clinical trials study a drug, a medical device or a new way of doing surgery. Others test new ways to prevent disease, diagnose disease, improve quality of life, or help people with diseases such as cancer manage difficult psychological and social issues. Some clinical trials are small, with just a few patients. Others are large and involve thousands of patients at large research centers.

Clinical trials have played an important role in the fight against cancer and other diseases. They are the only scientific way to prove whether a new treatment works better than current treatments. Most of the approaches that doctors use to treat cancer today would never have become available without clinical trials.

n What is an Institutional Review Board (IRB)?Under U.S. Federal Drug Administration regulations, an IRB is an

appropriately constituted group that has been formally designated to review and monitor biomedical research involving human subjects. In accordance with FDA regulations, an IRB has the authority to approve, require modifications in (to secure approval) or disapprove research. This group review serves an important role in the protection of the rights and welfare of human research subjects.

The purpose of IRB review is to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in the research. To accomplish this purpose, IRBs use a group process to review research protocols and related materials (e.g., informed consent documents and investigator brochures) to ensure protection of the rights and welfare of human subjects of research.

Kiran Avancha, PhD

An exciting future

The cancer programs at The Hospital of Central Connecticut (HOCC) in New Britain and MidState Medical Center in Meriden, both part of the Hartford HealthCare Cancer Institute (HHCCI), are partnering with the Southington YMCA to provide post-cancer treatment services to patients through the Y’s Livestrong program. Shown here are, from left, Linda Prus, health and wellness program coordinator for the Southington Y; John Myers, executive director of the Southington Y; Noa Mencher, RN, HOCC nurse navigator; and Kristoffer Popovitch, director of the Central Region for HHCCI. For more information, please go to www.thocc.org/cancer or www.midstatemedical.org/cancer.

HHCCI partners with the Southington YMCA

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On the coverKatherine Hsu, MD, center, an oncologist, hematologist and scientific researcher at Memorial Sloan Kettering Cancer Center, in one of MSK’s groundbreaking research centers

“Plus” checked in with Deborah Ford, manager of Facility Project Development, for an update on the new Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut. The new facility sits on a parcel of land overlook-ing Interstate 84 on the Plainville-New Britain town line.

The new cancer center will offer a full range of cancer services, as well as a medical office building for providers. It is expected to open in the spring of 2015. Construction in excess of 100,000 square feet began in January 2013.

C onstruction of the cancer center is progressing significantly. We

have completed above-ceiling inspec-tions on both the first and second floors in the main cancer center building, and ceilings, lighting, floor-ing and millwork are being installed throughout the facility.

The medical Office Building, where both imaging services and the new Comprehensive Breast Care Center will be located, is just a few weeks from starting the same process. Work on critical systems, such as the fire alarms, nurse call system, electrical system commissioning and elevator work is also in process.

We have been working with user groups to develop an activation cal-endar over the past months, and that process is completed. We will follow the same phasing plan for activation of the building as we did for con-

struction: second-floor cancer center first, first-floor cancer center second, and finally the first floor of the medi-cal office building.

Our information systems team is leading with installation of a com-munications network infrastructure. We expect to obtain a certificate of

occupancy for the cancer center by Dec. 30 and for the medical office building by Jan. 30.

We continue to target the first week of march for a licensure inspec-tion by the state Department of Public Health, with moves to follow on their approval.

Progress continues on HOCC cancer center site

Progress continues with the construction of the new Hartford HealthCare Cancer In-stitute at The Hospital of Central Connecticut. Above, work is nearly complete on the grand fireplace/staircase that will greet visitors in the main lobby. At left, the building exterior.

Q. Can you explain what a Disease Management Team is within the context of the Hartford HealthCare Cancer Institute (HHCCI)? How are individual teams established and who takes part?

A. Dr. Hosmer. Disease management Teams (DmTs) are the structure that allows for the stan-dardization and coordination of oncology care across all sites within HHCCI. They are organized based on disease sites: thoracic, gastro-intestinal, gynecologic, breast and genitourinary. The teams have repre-sentatives that span the geographic sites within the cancer institute and are composed of physicians from various specialties, nursing staff, research staff, and the institute executive leadership. Besides myself and Dr. Fumo, other DmT physician leads are genitourinary lead Anoop meraney, mD; gynecologic team lead Jonathan Cosin, mD; and breast team lead Patricia DeFusco, mD.

Q. In your view, what are some of the main advantages of utilizing the DMT model for providing the best care for patients?

A. Dr. Fumo. The DmT model has effectively brought multiple HHCCI sites throughout the State of Connecticut together and created a rich forum for continuing education, standardization of practice and adop-tion of clinical trials.

Q. Can you describe your role as a DMT physician leader?

A. Dr. Hosmer. As the physician leader of the thoracic DmT, my role is to assist in structuring ongoing

agendas for the DmT, facilitate dis-cussions on evolving standardization of care across the institute, coordinate research priorities for thoracic ma-lignancies and provide educational opportunities for DmT members. Each DmT also has an administra-tive leader who plays a pivotal role in coordinating and carrying out the mission for each DmT. Administrative DmT leaders include Carol Barrett for the thoracic DmT; Dawn Plumb for the gastrointestinal DmT; Jan Ruderman for the genitourinary DmT; and Karen Weingrod for both the breast and gynecologic DmTs.

Q. Did HHCCI’s membership in the Memorial Sloan Kettering (MSK) Cancer Alliance have an influence on the decision to adopt a DMT model of care?

A. Dr. Fumo. The DmT model for some disease sites did exist at HHCCI prior to our relationship with mSK, but our membership in the mSK Cancer Alliance has clearly broadened

and accelerated the process. The DmT model continues to promote the goals set by the alliance. For example, the DmTs serve to channel communication between these two very large organizations while also helping to disseminate important information among the clinicians who are caring for our patients (policy to practice).

Q. Do you envision the role of DMTs expanding as the Institute continues to evolve?

A. Dr. Hosmer. I am certain that the role of the DmT will continue to expand as the institute evolves. The DmT will be the vehicle for modifying any standards of care, communicat-ing changing practices to institute members and overseeing the expand-ing research opportunities provided by the mSK Alliance.

Q. Why should referring physi-cians and patients feel confident that the DMT model will meet their needs?

A. Dr. Fumo. Every decision or pro-cess that results from the DmT model has gone through a very rigorous and thoughtful evaluation involving multiple specialty disciplines with a single goal in mind: To provide the best cancer care in our communities throughout Connecticut.

Gerard Fumo, DO, specializes in medical oncology and hematology at the Hartford HealthCare Cancer Institute at MidState Medical Center. Wylie Hosmer, MD, specializes in medical oncology at the Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut.

Disease Management Teams are the foundation for care

Q&A with

Gerard Fumo, DOGastrointestinal Oncology

Disease Management Physician Team Lead

and

Wylie Hosmer, MDThoracic Oncology Disease

Management Physician Team Lead, Hartford HealthCare

Cancer Institute

The month of November was marked by a high-profile effort across Hartford HealthCare to call attention to men’s health issues as part of the national “Movember” campaign. Male em-ployees throughout the organization were encouraged to show their support by growing beards or mustaches, including, shown here from left, Mohamed Saleh, performance improvement facilitator for Hartford HealthCare; Dr. Anoop Meraney, lead of the urologic oncology Disease Management Team for the Hartford HealthCare Cancer Institute; Dr. Gerard Fumo, lead of the gastro-intestinal oncology Disease Management Team for the Hartford HealthCare Cancer Institute; and Kris Popovitch, director of the Central Region for the Hartford HealthCare Cancer Institute.

A ‘Movember’ to remember

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News from the Hartford HealthCare Cancer Institute

Rendering optionsHHCI andMemorial Sloan Kettering Cancer Alliance Member1/25/2014

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Donna Handley

Vice President of Operations, Hartford HealthCare CancerInstitute

The name we call ourselvesWhat’s in a name? A lot, especially when we’re

raising awareness about the Hartford HealthCare Cancer Institute and the comprehensive and coordinated cancer services we offer across Connecticut. We are proud of what we have cre-ated, and we need to identify our Institute in a consistent manner so it gains recognition.

So, I’d like to explain how and why we are now referring to ourselves across our system.

At all our cancer centers, we are now known as:The Hartford HealthCare Cancer Institute at

[name of hospital*] (*Backus Hospital, Hartford Hospital, The Hospital of Central Connecticut, MidState Medical Center, Windham Hospital)

We are working with our colleagues in the Fund Development and marketing departments across our system so that we continue to honor, in all appropriate ways, the gifts and legacies of those whose names are attached to some of our programs. These include the Helen & Harry Gray Cancer Center at Hartford Hospital and the George Bray Cancer Center at HOCC.

Therefore, in brochures, stories and other ap-proved materials, we will continue to refer to these

centers in printed copy. We also will ensure that the names of these individuals are recognized in appropriate signage within our Institute’s cancer centers.

I understand and appreciate the affinity you may have for the individual cancer centers where you work or care for patients or, in the case of patients, receive care. This sense of pride and loyalty is com-mendable. Yet, in order for people to understand what we are about and the full range of services available to them, it’s critical that we convey a broader awareness of what we have created and why the Institute model matters.

We recognize that patients at all of our cancer centers are accustomed to calling us by the names they are familiar with. Patients and providers and staff all will benefit greatly from our Cancer Institute, and in time, everyone will recognize that and call us by our name. But only if we start doing that now.

I thank you for your help.

Plus

In this issuen Disease management

Teams: The foundation for care

n Leading-edge surgical procedure for HHCCI cancer patients

n Hormone therapy helps patient overcome disease

News from the Hartford HealthCare Cancer Institute

HHCCI to begin MSK clincial trials

P atients who receive care within the Hartford HealthCare Cancer Institute (HHCCI) will have

a powerful new treatment option avail-able to them early next year when the memorial Sloan Kettering (mSK) Cancer Center opens access to select offerings from its world-renowned portfolio of clinical research trials as part of HHCCI’s membership in the mSK Cancer Alliance.

mSK, widely recognized as one of the premier cancer research centers in the world, has more than 800 research trials and protocols in progress. In November, the cancer center identi-fied the trials and protocols suitable to share with HHCCI, which is the charter member of the mSK Cancer Alliance. mSK hopes the Alliance will create a broader population of patients who can gain access to trials, while HHCCI

is taking advantage of the relationship to implement an elevated standard of care for patients.

“We are thrilled to begin the process of identifying those trials that are best suited for HHCCI’s patients,” said Paul Sabbatini, mD, mSK’s deputy physician-in-chief for clinical research. “This is not only a great opportunity for

See TRIALS, page 6