In Massachusetts, and in Northampton and Amherst particularly – deviating from the national statistics – a leading cause of death per 100,000 people is cancer, followed by heart disease.
This statistic, along with notably high incidence rates of cancer within our state and community is the backdrop against which Cooley Dickinson Hospital is creating a cancer center.
Why a Community Hospital like Cooley Dickinson Should Focus on Cancer
Our mission at Cooley Dickinson is to be a national model of community hospital excellence. This means we strive to provide the highest quality medical care for our community and, when possible, to provide services most demanded by people in our service area. There are some illnesses, particularly those that are extremely rare and specialized, that are best served at tertiary or quaternary facilities; and referring to these facilities makes practical and financial sense. Cancer, by contrast, is a highly prevalent disease, whose diagnosis and treatment are ideally suited to a community hospital for a number of reasons:
• Though a cancer diagnosis is serious and often frightening for patients and their families, cancer is an illness that – by and large – can be well served locally. In fact, Cooley Dickinson has the clinical and technical expertise to provide 85% of all cancer treatment.
• Cancer is not just an individual patient’s condition; it is very much a family condition – often requiring intensive support of family and friends. Hence, it is an illness best treated in a patient’s home community, where his/her support network is nearby. And it’s not just patients who benefit from nearby support. Family and friends, for whom the experience can also be stressful, can receive support from the interdisciplinary team as well.
• Proximity is critical. Cancer treatment usually takes place over extended periods of time and is an exhaustive and exhausting process for patients and their families. Patients should not have to invest precious time, energy, and money traveling to receive the cancer care they need.
Currently, the nearest cancer center in western Massachusetts is in Springfield, approximately a thirty-minute drive from Northampton. Thirty four percent of Cooley Dickinson’s cancer patients already drive over 11 miles to come here, with some driving over 40 miles, and they would be further inconvenienced if they needed to travel to Springfield or to cancer centers in and around Boston, nearly ninety miles away. The Cancer Center at Cooley Dickinson will eliminate the need to travel for literally hundreds of patients and their families, thus obviating a major source of stress.
• Patients benefit from well-coordinated systems of care that address medical, physical, psychosocial, and spiritual needs at all points along the cancer journey. Even if patients require services performed away from home, they and their families will benefit from having their care coordinated locally – giving them the best of both worlds.
• For cancer patients who are well enough to work, access to a local cancer center gives them the option to continue working while receiving treatment. For patients, the possibility of this option can ameliorate economic pressures. This option can also be a boon for businesses/employers concerned about minimizing lost productivity.
• The technological investment required for cancer treatment is one that makes sense within the financial framework of a community hospital.
• The high incidence of cancer – a leading cause of death in our service area and in Massachusetts – makes it a disease any facility devoted to community health and local access would aim to address.
The Massachusetts General Hospital Cancer Center Connection
In keeping with our commitment to bring our community the best medical care possible, Cooley Dickinson Hospital secured a collaborative agreement in 2009 with Massachusetts General Hospital’s Cancer Center, a world-class leader in the field. The Cooley Dickinson Board of Trustees selected Massachusetts General Hospital as a tertiary partner in 2012.
Sean Mullally, MD, medical oncologist and Medical Director of the CDH Cancer Care Program, says, “To have the opportunity to receive top notch cancer care close to home and have easy access to world-renowned care truly does provide our patients with the best of both worlds”.
CDH’s agreement with a world-class cancer center offers multiple benefits for patients, including the following:
• Facilitates easy access to MGH Cancer Center specialists, as well as timely referrals for second opinions and treatment plans for the most specialized cancers.
• Facilitates consultations between MGH subspecialty medical, surgical, and radiation oncology specialists and CDH patients, physicians, and staff.
• Facilitates the creation of individualized patient care plans that may draw on MGH’s clinical and psychosocial resources any point on the continuum of care.
• Provides easy access to joint medical education and quality support programs, some of which are on-site at CDH.
• Provides access to MGH’s genetic counseling resources and expertise. A licensed genetic counselor has an office at CDH to see patients on campus for counseling and testing if recommended.
• Facilitates access for entry into clinical trials as appropriate.
• Facilitates collaboration on community outreach and education programs related to oncology, based on the most prevalent and documented health needs of the area residents.
• Potential to facilitate on-site oncology-related subspecialty expertise by MGH physicians.
Collaboration with a world-class organization like Massachusetts General gives the Cooley Dickinson Cancer Center a major advantage, both in clinical terms and in the assurance for patients that they are receiving the best cancer treatment and follow-up care available.
THE IMPORTANCE OF BEING A CENTER
It is impossible to overemphasize the importance of being a Cancer Center. Cancer is a disease which has both chronic and acute phases. It can strike virtually every system of the body, and patients depend on the coordinated efforts of many medical professionals to be treated successfully.
Over the past 10-15 years, the three main modes of treatment – surgery, radiotherapy, chemotherapy – as well as hormonal therapy have become more complex and technically sophisticated. As a result, management of the patient with cancer has become more complex, and cancer care has evolved from involving a surgeon or oncologist to involving a multi-disciplinary team approach.
At the same time, the cancer care has moved from a primarily inpatient setting to an outpatient setting. Patients come for outpatient treatment and return to their families or work environment with little ongoing contact with others who are on a similar journey.
Patients often describe a frightening sense of isolation, when they can’t talk to other people going through a similar experience. Patients receiving radiation therapy on a daily basis sometimes fear, rather than embrace the end of treatment, because they don’t want to lose the social contact that daily treatment has necessitated.
When a patient’s multiple health care professionals are in different locations, the patient can experience an increased sense of isolation, and the possibility of communication-gaps between providers widens. Patients and their families frequently worry that they, and their medical records, will fall through the cracks, leading to medical setbacks and complications. Additionally, they grow weary of having to tell their “story” repeatedly.
All these changes in the delivery and receipt of cancer care have resulted in the rise of comprehensive cancer centers, where the emphasis on coordinated care has led to stronger outcomes and a more positive experience for patients and their families.
Market research conducted in 2009 indicates that both healthcare consumers and primary care physicians are highly positive about the idea of a Cancer Center at Cooley Dickinson Hospital. Consumers agreed that they would use a Cancer Center at CDH over other options in western Massachusetts. For some patients, such as CDH’s radiation therapy population, where nearly 50% of patients are over the age of 65, local access that minimizes travel time is absolutely critical. Consumers and physicians agreed that a comprehensive cancer center in a single-unified space would significantly increase patients’ confidence in the care they could expect to receive.
THE NEW COMPREHENSIVE CANCER CENTER AT COOLEY DICKINSON
Our vision at Cooley Dickinson is to create a comprehensive cancer center that will combine the best that science has to offer with the best that a community hospital can provide – all into a single, unified space. The Center will be firmly grounded in the very latest research and clinical practices, but also infused with all the life-affirming benefits of serving patients “at home” in their community. Patients will benefit from well-coordinated systems of care that address medical, physical, psychosocial, and spiritual needs at all points along the cancer journey. In most cases, cancer patients will be able to receive much of their treatment locally – so they can draw on the support of family and friends. Patients will also benefit from our collaboration with the Massachusetts General Hospital Cancer Center, one of the leading centers of its kind. They’ll have easy access to the world’s finest oncologists and oncology services. Even if patients require services performed away from home, they and their families will benefit from having their care coordinated locally – giving them the best of both worlds.
Building Strength Upon Strength
Accreditations and certifications Cooley Dickinson’s current Cancer Care program has been accredited by the American College of Surgeons-Commission on Cancer (AcoS-CoC) since 1978. The survey process occurs every three years with several mandatory quality standards covering all aspects of cancer care including but not limited to quality improvement, community outreach, leadership, prevention and early detection and quality outcomes. In the last survey year, September 2011, the Cooley Dickinson Hospital’s Cancer Care Program was awarded a three-year accreditation with five commendations.
Quality Indicators Quality care has been a hallmark of our Cancer Care Program. A recent study bears this out. On five of six separate quality indicators that are collected annually by the National Cancer Data Base, Cooley Dickinson Cancer Program’s performance rates matched or exceeded the specifications of the breast, colon, and rectal cancer care measures, with Cooley Dickinson reaching 100% in four measures. The sixth quality indicator is not reported at this time.
Outstanding Staff The well-coordinated efforts of our formidable cancer staff will be the beating heart of the new cancer center. Collectively, our oncologists have more than 100 years of experience. They and the oncology support staff have a proven track record with their patients; we routinely receive outstanding letters and feedback. They’ve worked at major tertiary facilities. They consistently get referrals from oncologists at major cancer centers, including Massachusetts General Hospital Cancer Center and Dana Farber. Their study and training is ongoing.
An interdisciplinary approach is at the core of CDH’s treatment philosophy. CDH’s board certified oncologists work together with pathologists, surgeons (including a plastic surgeon and surgeons with expertise in minimally invasive surgery), radiologists, pulmonologists, and specially-trained nurses, social workers, and other specialists – to determine the diagnosis and appropriate treatment of each patient. Administrative staff help ensure that there is a smooth “flow” and communication between appointments and specialists.
World-Class Technology Technology in cancer care is advancing at a rapid speed in the areas of diagnostic imaging, treatment planning, and radiation therapy. In early 2010, with support from a $1 million bequest, Cooley Dickinson purchased the Elekta Synergy, a $3.2 million advanced digital linear accelerator, giving patients in our community access to the latest radiation oncology treatment technology available. The renovated Vitkauskas Crowe Radiation Oncology Suite includes the Elekta Synergy and a second linear acclerator, as well as a department dedicated CT simulator with a sophisticated state-of-the art physics component for treatment planning and quality control.
In addition, Cooley Dickinson offers two MRIs offering breast screening for high-risk women, full digital mammography and MRI Guided Breast biopsy equipment, and a PET/CT scanner.
Patients requiring surgery can also take advantage of a major hospital addition: the $50 million Patient Building and Kittredge Surgery Center, that opened in April 2007 and offers single-patient rooms and six new operating suites. In 2007, the hospital purchased a $1.6 million daVinci S robotic surgery system, which augments the hospital’s minimally invasive surgery program. Robotic surgery translates into shorter hospital stays, decreased risk of infection and blood loss, and increased patient comfort – all of which means better clinical outcomes for the patient. Only 10% of the hospitals in the United States have robotic technology.
CDH is the first hospital in the Northeast and one of the first in the United States to acquire the Xenex PX-UV Disinfection System, which uses pulsed xenon ultraviolet light to disinfect patient rooms and prevent hospital-acquired infections. The system is used in conjunction with traditional cleaning processes. Before implementing the Xenex system, CDH had a rigorous infection prevention program in place and our infection rates were already lower than the national average. With this new technology, the chances of getting an infection, such as Clostridium difficile (C-diff.) in this hospital are less than 1 percent, compared to a 5 percent risk in general in the nation.
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The new cancer center will bring together all of our extensive cancer services – including medical and radiation oncology, and supportive and ancillary services such as nutrition, social work, pastoral care, imaging, rehabilitation, and laboratory services – into a single, well designed, welcoming space, where the whole is greater than the sum of its parts.
For patients, the benefits of centralizing cancer services are legion. Because all their cancer needs can be addressed in one place, patients can save the time, energy, and effort of having to travel from office to office. A patient navigation program will guide patients through the complexities of treatment and coordination of care, while also helping them access information and support services. Patients will be spared having to tell their cancer story over and over, because all their caregivers will have easy access to real-time, instantly updated patient information, including medical records, lab reports, and imaging. And communication between a patient’s caregivers will be greatly enhanced.
When a second opinion or specialized treatment at Massachusetts General Hospital Cancer Center or other tertiary center is needed, centralization of services and patient information will ease the way. And when patients and their families return to CDH for continued care or follow-up, they can rest assured that their transition between care providers is seamless and transparent.
A major draw of a community hospital-based cancer center is that it can offer personal, approachable, and coordinated multi-specialty care in a centralized location. Our ongoing focus and goal will be to know patients by their names, and to have every member of the medical team be knowledgeable about the development and progress of that patient’s case.
The new Center will also retain the kind of small-town touches unlikely to be found in a major cancer center. Currently, in the office of Dr. George Bowers, for example, patients can encounter Auggie, the therapy dog – a specially trained canine who offers comfort and comforting distraction to those who come for treatment and office visits.
Patients and families will also have easy access to an oncology library and media center, staffed by a medical librarian who can help them successfully navigate a confusing network of information. Knowledge is power. For many cancer patients, learning as much as they can about their illness can give them a sense of control, which can be very reassuring. In the library, the Shared Decision Making Center will provide the most up-to-date educational information on treatment options, helping them make decisions about their care.
Cancer center patient will also benefit from improved patient safety. By limiting patients’ exposure to the germs and illnesses throughout the rest of the hospital, the Center will help to minimize infection, especially in patients made vulnerable by chemotherapy.
The Cancer Center will be a place where patients and families can engage with others who are on the cancer “journey,” by joining ongoing support groups and utilizing a rich range of services designed to ease some of the isolation that accompanies this journey.
Plans for the Center also include the addition of three new positions—for which we are seeking funding – that will further improve the lives of our cancer patients and their families. A patient navigator, whose primary focus will be breast cancer, will help navigate patients to appropriate specialists and follow their treatment course as appropriate. A registered dietician will work closely with patients whose nutritional status is compromised by their disease and/or treatment course. And a financial counselor, an expert in the financial management of oncology patients, will work with the cancer care team to help underinsured or uninsured patients to resolve financial stressors related to their cancer diagnosis or treatment.
Location, Site Components, and Layout
The new Cancer Center will be located directly above radiation oncology. The Healing Garden, a sanctuary of natural beauty and light, is close to the Cancer Center and will provide a peaceful retreat for cancer patients and their families. The Gugger Family Memorial Chapel is in the space adjoining the Healing Garden.
The Center will offer a wider range of services, each in their own dedicated space.
Medical Oncology Physician Practice
Medical Oncology/Hematology will be the primary service in this setting. The practice has plans to include space for up to four physicians with the potential of 1 or 2 mid-level practitioners over time. The physicians will have private office space in the practice area.
• The primary area will include patient examination rooms, consultation rooms for personalized patient and family meetings.
• This area will also include an infusion suite for chemotherapy; a space for patient socialization; space for patient privacy; a centralized nursing area, with private space for procedures commonly performed by the nurses.
• A nutrition center will be accessible for the comfort and convenience of patients and family being actively treated.
• An easily accessible phlebotomy suite.
Patient Reception/Registration/Scheduling will offer patients privacy as they check-in or check-out, register, and schedule appointments.
Medication Storage/Chemo mixing will also include a pharmacy, furthering the convenience of one central location for our patients.
Multi-specialty examination rooms will be used by surgeons, radiation oncologists, interventional radiology, radiologists, palliative care consultation, etc., to interact with patients and their family for consultations and examinations. When a patient needs to see several physicians, these specialists will come to patient, not visa versa, minimizing patient movement throughout the hospital within the day.
Multi-purpose consultation rooms will be used by physician specialists, nutritionists, social worker, pastoral care, etc., for consulting with patients and families. Again, these rooms will be used in such a way that brings medical services to the patient, minimizing
patient movement, and inconvenience.
Patient Waiting Area is being designed to offer maximum comfort to patients, families, and caregivers.
Multi-purpose Conference Room, designed to accommodate up to 30 people, will be used for weekly cancer conferences; community/patient educational and informational programs; staff & physician educational programs, peer support program, etc. It will also be used as a patient drop-in center, and may be staffed by volunteers or post-treatment patients who want to “give-back” to their community hospital and the Cancer Care Program.
Medical Library/Media Center will house both printed and digital materials on oncology. Patients and families will have access to computers with a DVD option. (See p. 8 for more information)
Complementary Therapy Suite will be included if space allows, to accommodate ongoing classes (up to 20 people), such as yoga, medication, group support, etc. Individual private rooms will be available for Reiki, massage, therapeutic touch, etc.
Preliminary Site Plan
Cooley Dickinson has developed a physician-based palliative team that actively works with patients and families who face what can be a complex spectrum of issues, including pain management, symptom support, and coordination of care. Perhaps a patient and his/her family seek to maximize pain medication. Maybe a family member needs special support dealing with stress. Or a patient wants guidance about dealing with a will or a financial issue. CDH’s palliative care team extends its services to patients and their families while they are at CDH, and also when they return home to their community.
The hospital’s palliative care team includes a board certified palliative care physician (AAHPM), a certified hospice RN (CHPN), a hospital social worker, and a pastoral care counselor. Motivated by the ultimate goal of improving quality of life, this team directly helps patients and families handle their particular issues, or make the appropriate referrals that fulfill their need.
A TREMENDOUS OPPORTUNITY TO MAKE A DIFFERENCE
A multiplicity of factors – cancer’s community-based nature; CDH’s already extensive cancer capabilities; the MGH collaboration; the scale of technological investment, and the high demand for cancer care in our service area – all work together in a way that serves the medical needs of our community and the financial health of our hospital.
So many elements of a strong cancer center are already in place. In recent years, we’ve steadily strengthened our oncology staffing. We’ve invested in surgery, and patient rooms. Recent technological purchases and our collaboration with Massachusetts General Hospital Cancer Center further reinforce our decision to unify our strengths into a Center, where the whole will be far greater than the sum of its parts.
The new Cancer Center at Cooley Dickinson presents an opportunity for you to make a tremendous difference in our community. When you give to the Cancer Center, not only will you simplify and improve the lives of individual patients, you will simplify and improve the lives of the patients’ families and friends.
Because a successful Cancer Center will help Cooley Dickinson retain and recruit more talented physicians and advance the hospital’s overall financial viability, your gift, ultimately, will influence the future health and well being of our hospital and our entire community.
You can help us address a leading cause of death in our state and community. With your support, we will succeed in raising the $5 million we need to create a cancer center in our community that truly and comprehensively meets the needs of cancer patients and their families.
Thank you for your consideration.