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JANUARY 2015 | ISSUE 12

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

Compacts are good for patients — and physiciansWhen the Hartford HealthCare Cancer Institute

(HHCCI) was formally certified as the charter mem-ber of the Memorial Sloan Kettering (MSK) Cancer Alliance last September, it was clear that our mem-bership in this pioneering alliance would hinge in large part on the willingness and commitment of our medical staff to carry out our vision of clinical integration and affiliation.

Aligning with standards as established by a world-class partner like MSK is good not only for our Institute or the patients who come to us for care — it is also good for our physicians. As enor-mously skilled and accomplished as our physicians are, the opportunity to share and learn with other experts in the field can only help broaden our abil-ity to bring the very best care to patients.

With that in mind, one of the requirements of membership in the alliance is a written compact that our physicians will be asked to sign in order to be considered a part of HHCCI and the MSK Alliance. Such compacts are becoming increas-ingly common at healthcare organizations across

the country due to dramatic shifts in the health-care landscape.

Some physicians have raised concerns that these changes may be detrimental to their profes-sion, but in truth, they signal an opportunity for physicians and organizations to work more closely together. Our goal of eliminating long-standing obstacles to patient care and working collabora-tively to provide coordinated care will be supported through the development of the compact, which we are calling the HHCCI Physician ComPACT. This is an opportunity for physicians to work in a mul-tidisciplinary team-based culture in which their expertise and skills will be put to even better use.

Creating that culture begins with the physician compact, which is why I’m asking our physicians to view the compact for what it is — an opportu-nity to bring enhanced care to patients.

Plus

In this issuen The importance of

nutrition in treating and preventing cancer

n How the state’s medical marijuana laws can benefit patients

n Living to run again: A patient’s story

News from the Hartford HealthCare Cancer Institute

Physician compacts built around a team-based approach to care

A s the Hartford HealthCare Cancer Institute (HHCCI)’s membership in the Memorial

Sloan Kettering (MSK) Cancer Alliance continues to evolve, physicians who practice within the Institute soon will have the opportunity to enter into an agreement that reflects the goals

behind the alliance and outlines the commitment to clinical integration across the Institute.

Anyone who participates in disease management teams and who practices — including Backus Hospital, Hartford Hospital, MidState Medical Center, The Hospital of Central Connecticut and

Windham Hospital — will be asked to sign a physician compact that reflects the changing role that providers are being asked to fill as part of HHCCI and its relationship with MSK.

HHCCI is the charter member of the

See COMPACTS, page 2

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HHC CanCer InstItute at tHe HolIdays

7

On the coverOne of the benefits of a physi-cian compact such as the one being drafted for physicians within the Hartford HealthCare Cancer Institute is the oppor-tunity it will provide for closer collaboration among medical staff and other caregivers in various specialties across the Institute. Here, members of the breast cancer disease manage-ment team for HHCCI contrib-ute to a recent discussion on some of the latest advances in research and treatment. From right to left, Diana James, MD; Thomas Banever, MD and Andrew Ricci Jr., MD.

F or the past 17 years, the United

Technologies Corporation (UTC) has donated gifts, money and time to sponsor an an-nual holiday party for pediatric cancer patients at the Hartford HealthCare Cancer Center at Hartford Hospital.

Pediatric cancer patients who have received treatment at the center look forward to the party every year. Highlights include arts and crafts such as face painting, fingernail polishing and origami, as well as holiday food and drink — not to mention a visit from

Santa. Volunteers from the Radiation Oncology Department — including therapists and nurses who treated these patients, along with office staff

— greet the patients and help them with the activities. Toys for all ages are placed under a holiday tree for the patients to choose from. Then the patients get to tell Santa and Mrs. Claus what they want while sitting on their laps.

This year’s party featured a “Polar Express” theme, com-plete with a hot cocoa bar with mini marshmallows, whipped cream, sprinkles and holiday straws along with and

candy bars. While waiting for Santa, patients listened to Rick the Train Conductor read them a story.

staff joins with utC to host party for pediatric patients

Staff members at the Hartford HealthCare Cancer Institute at Hartford Hospital donated numer-ous gifts to adopted families over the holidays. The Cancer Clinical Research Office raised several hundred dollars to buy gifts for a family selected through the Adopt-A-Family Program. Staff members with the donated wrapped gifts shown here are, from left, Anne Clark, Bridgette Boucher, Nicole Sinclair, Susanne Morrill, Tamara Montgomery, Karen Cuddy, Anna Joseph and Oma Ogazi. Not pic-tured is the rest of the staff who also made contributions: Edith Clark, Catherine Enero, Kiran Avancha, Thomas Yakoubian and Jessica Bello. The cancer center’s infusion services team also donated gifts to an adopted family, including a set of bicycles, shown here.

Thomas Lesnik, MD, led a group of carolers and musicians throughout Backus Hospital the week before Christmas as they offered a little holiday cheer to patients and staff. Dr. Lesnik says it’s a tradition he began 40 years ago when he first came to Backus and each year he is joined by staff from surgical services and other departments as well as local musi-cians.

Cancer center teams donate gifts to adopted families

Backus sing-a-long

MSK Cancer Alliance, which was es-tablished to make MSK clinical trials and research protocols to a broader population of patients. This is part of HHCCI’s mission to create a single standard of care across all of the cancer centers within the Institute.

Signing the compact goes hand in hand with the opportunities that will be available as part of HHCCI’s membership in the MSK Cancer Alliance. In fact, the creation of the compact was one of the conditions that HHCCI was asked to meet in or-der to become certified as a member of the MSK alliance.

The compact, which is in the pro-cess of being drafted, will ask physi-cians to make several commitments and adjustments in some of the ways they have traditionally worked with cancer centers and hospitals to provide care for their patients. At the same time, the compact will provide commitments to physicians in terms of resources and relationships.

“The traditional model of pa-tient care in which physicians have operated autonomously or indepen-dently of hospitals or hospital-based caregivers is shifting dramatically,” said Donna Handley, vice president of operations for HHCCI. “As the

largest provider of comprehensive cancer care in our region — and as part of our pioneering partnership with MSK — our Institute needs to quickly and efficiently adapt to these new realities so that patients receive the very best care possible.”

While the compact will ask physi-cians to commit to several adjust-ments in traditional models of care, the document also will outline numerous areas where physicians can expect to receive critical re-sources from the cancer programs across HHCCI as well as MSK, Handley said.

“The compact is a two-way street,” she said. “We realize we are asking physicians to make adjustments and to be adaptable, but we also want them to know we will assist them with the resources they need to make these adjustments successfully.”

The compact is expected to ask commitments of physicians in sev-eral areas, including adopting clini-cal standards of care as established by the disease management teams (DMTs) within the Institute. Other commitments expected to be in the compact include:n Ensuring that the infrastructure

is in place for patients to receive ac-

cess to MSK clinical trialsn Creating a platform and access

to an electronic medical record n Participation in HHCCI confer-

ences, DMTs and goalsBenefits that physicians can ex-

pect under the compact include:n Access to early-phase and novel

clinical research trials, including MSK trialsn Access to nurse navigators to

ensure seamless integration of ex-cellent care for patientsn Branding opportunities as mem-

bers of MSK AlliancePhysician compacts have become

increasingly commonplace in recent years as healthcare organizations adjust to new realities that empha-size value-based outcomes for pa-tients instead of traditional models based on volumes.

One of the main advantages of compacts, Handley said, is that they encourage physicians to become more engaged with the hospitals and healthcare settings where their patients receive care.

The goal is to create a culture in which physicians view their role as a critical part of a multidisciplinary team providing comprehensive, coordinated care to patients.

COMPACTS from page 1

Anca Bulgaru, MD, a medi-cal oncologist at Eastern Connecticut Hematology and Oncology, talks about genetic testing for breast cancer during a special presentation for medi-cal, nursing and oncology support staff. Dr. Bulgaru described the contribu-tion of genetics in breast cancer risk and explained how genetic test results can be used to reduce that risk. The presentation was given at the Hartford HealthCare East Region Support Office in Norwich.

Breast cancer testing

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Engine Co. 3 of the Newington Fire Department presented a check for $9,239 to Wendy Lux, fund development director for The Hospital of Central Connecticut (HOCC), to mark the end of the fire company’s “pink truck” campaign to raise money for the new cancer center at HOCC. Last spring, the fire company had one of its trucks wrapped in pink to show its support for breast cancer aware-ness, and the truck appeared at numerous community events throughout the spring, summer and fall. At each of the events, members of the company sold T-shirts, with proceeds going to the new cancer center, which is set to open later this year on the New Britain-Plainville town line. Shown here, from left, are firefighters Tim McDonald, Tim O’Brien, Craig Stegmaier, Wendy Lux of HOCC, Chris Ferri and Austin Muir.

Newington FD’s ‘pink truck’ campaign raises more than $9,000

The road to recovery

Former smoker benefits from early screening — and a dedicated team of physicians

we know about the chemistry of the human body. [It] neglects to recognize that it is ‘virtually impossible’ to create a less acidic environment in the body.” Still, there are some cancer-related diets that can be very healthy and nutritionally complete such as a vegetarian or a vegan diet, or a diet low in refined sugar. If patients want to try these diets, I help them find ways to comply with the diet.

Q: From a dietary standpoint, what are some of the benefits that the Hartford HealthCare Cancer Institute’s membership in the Memorial Sloan Kettering (MSK) Cancer Alliance will bring patients?

A: Our relationship with MSK will allow dietitians and nutri-tionists from both organizations to share standards of practice and best practices to provide the best patient outcomes. We can also share specific protocols for nutri-tion interventions for different cancer types — for example, for individuals with head and neck cancer, who tend have numerous nutrition-related complications during and after treatment. We will be working together in the disease management teams to develop and share our prac-tices so that consistent Medical Nutrition Therapy is provided to all patients.

Elizabeth Churchill, RDN, CSO, CDN, is a registered dietitian/nutritionist who is board-certified as a special-ist in oncology nutrition from the Academy of Nutrition and Dietetics, the world’s largest organization of food and nutrition specialists. She has been an oncology nutrition specialist at the Hartford HealthCare Cancer Institute for more than four years.

NUTRITION from page 5

Ellen Dornelas, PhD, director of quality of life programs for the Hartford HealthCare Cancer Institute (HHCCI), was a featured guest on the Friday, Dec. 5 episode of the popular WNPR radio program, “Where We Live,” hosted by John Dankosky. The show centered around the journey of patients who complete cancer treatment and then strive to recover both emotionally and physically, and how best to meet their needs. Dornelas spoke about the many resources available across HHCCI to help patients resume a full and happy life after treat-ment. A podcast of the program can be heard at http://wnpr.org/post/support-ing-survivors-cancer.

R ichard Caplan smoked a pack of cigarettes a day for more than 30 years, but

quit the habit four years ago after watching his daughter complete the New York City Marathon. Inspired, the 65-year-old Wallingford resident took up running himself, building up to an average of four to five miles ev-ery other day, and discovered that he no longer had an interest in smoking.

But despite his apparent good health, his wife, who is a pallia-tive care provider at The Hospital of Central Connecticut (HOCC), urged him to undergo a free low-dose CT scan lung screening at HOCC, which, as part of Hartford HealthCare, was one of the first hospitals in the state to offer free screenings last year. The screening program was implemented based on findings in the National Lung Screening Trial (NLST) that concluded that screenings are an effective way to detect lung cancer in its early stages.

Caplan, who fit the criteria for the screenings as established by the NLST, was relieved to learn that no cancer had been found in his lungs, but stunned to learn that a large mass had been found on his thymus which would require surgi-cal removal.

After consulting with both his primary care physician and his wife, Caplan made an appointment with surgical oncologist Dr. James Flaherty at HOCC, who told Caplan that the mass could be removed without opening up his chest by using a minimally invasive proce-dure that called for a series of small incisions on the side of his body. The procedure would take about 50 min-utes, Dr. Flaherty estimated.

But as the procedure got under way, Dr. Flaherty discovered that the mass had extended beyond the thy-mus and had wrapped itself around part of Caplan’s heart. So instead

of performing a relatively simple 50-minute procedure, the surgeon spent more than five hours meticu-lously and thoroughly removing the mass from Caplan’s heart.

Once the procedure was complete, Caplan was apprehensive about the possibility of requiring follow-up chemotherapy. But because all traces of the mass were successfully re-moved, he was able to avoid chemo-therapy and underwent an addition-al five weeks of radiation therapy performed by Dr. Neal Goldberg’s radiation oncology team at HOCC.

Caplan is among more than 800 patients who have received free screenings across the Hartford HealthCare Cancer Institute over the past year. He is profoundly grateful for the programs and services that were provided to him.

“I have to say that all of the people who cared for me in this case were extremely impressive,” said Caplan, a social worker. “I always got the sense that everyone was fully com-mitted to helping me get through this in good shape, and that’s what they did.”

I always got the sense that everyone was fully committed to helping me get through this in good shape, and that’s what they did.

— Richard Caplan, Wallingford

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Connecticut adopted a statute legal-izing the use of medical marijuana for

certain types of pa-tients in 2012, and earlier this year, the state opened its first mari-juana dispensaries. Connecticut is one of 23 states across the country, as well as the District of Columbia, to adopt laws for the

legal use of marijuana for patients with chronic health conditions, including can-cer. The Connecticut law allows qualified patients to receive physician-authorized

prescriptions on a monthly basis.Many consider the use of medi-

cal marijuana to be controversial or questionable, as the drug is widely recognized for its recreational use. Yet increasingly, research is showing that marijuana can bring legitimate medi-cal benefits to patients suffering from a variety of ailments.

“Plus” asked Andrew Salner, MD, med-ical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, to share his thoughts on the benefits of medical marijuana for cancer patients.

M edical marijuana may help to control and palliate

symptoms for patients with selected

medical conditions. In particular, it might help to alleviate pain, appetite loss and nausea for selected cancer patients; eye pressure for selected glaucoma patients; seizure frequency and intensity for selected epilepsy patients; and spasticity for selected patients with neurologic conditions — among other possible benefits. In Connecticut, debilitating medi-cal conditions recognized under the state’s medical marijuana statute include: cancer, glaucoma, positive status for Human Immunodeficiency Virus or Acquired Immune Deficiency Syndrome, Parkinson’s Disease, mul-tiple sclerosis, damage to the nervous tissue of the spinal cord with objec-

research suggests marijuana can benefit patients, but lingering questions remaintive neurological indication of intrac-table spasticity, epilepsy, cachexia, wasting syndrome, Crohn’s Disease and Post-Traumatic Stress Disorder.

Connecticut’s marijuana statute is perhaps the most stringent in the country, with provisions requir-ing physician certification that the patient has a qualifying condition, as well as patient registration. The six approved dispensaries in Connecticut require a registered pharmacist to counsel the patient and dispense the appropriate format of the medica-tion. These regulations should help to decrease the risk of fraudulent acquisition of the medication and ensure safe dispensing.

The state selected four growers and six dispensaries following a competi-tive process, and product was finally available for sale in the fall of 2014. Over the next six months, growers will make available different formats (vaporizable liquid, oral and others) and different cannabinoid composi-tions which will benefit patients in different ways and require some personalization for patients in consultation with the dispen- sing pharmacist.

Since medical marijuana is not an FDA-approved drug, and marijuana has been listed as an illegal sub-stance by the federal government, physicians and other providers have

not had the benefit of the usual edu-cational materials that are available when new drugs are released, such as indications, doses, toxicities and side effects, and mechanisms of action.

This dearth of education, along with the stigma of marijuana as an illegal drug, and fear of prosecution, has made many providers reluc-tant to participate in the program. This will gradually change as there is increased experience, increased demand by patients, greater scientific data, and more educational programs available. It clearly will not be a pan-acea for everyone, but it will likely be helpful in selected patients.

Andrew Salner, MD

Hot topics

Q: Broadly speaking, what is the evidence that supports the role of proper nutrition in the care of can-cer patients?

A: Many studies suggest that providing education and resources about nutrition during cancer treat-ment may lead to fewer side effects, fewer hospitalizations and better quality of life. Inadequate manage-ment of side effects and symptoms can result in a decline in a patient’s nutritional status and potentially lead to malnutrition, which has been linked to poorer treatment outcomes.

Q: Is there any evidence that poor or improper nutrition contributes to the incidence of cancer?

A: An estimated one-third of some of the most common cancers and one-quarter of cancer overall could be prevented by healthy pat-terns of diet and physical activity. The American Institute for Cancer Research and the World Cancer

Research Fund developed recom-mendations for cancer prevention that were based on systemic reviews of the literature on food, nutrition, physical activity and cancer.

Q: How can proper nutrition help prevent cancer?

A: The key to a healthy cancer-prevention diet is consuming a predominantly plant-based diet. High consumption of a variety of plant foods protects against cancers at various sites. Plant foods are rich

in phytochemicals, vitamins and minerals. Foods containing selenium and lycopene protect against pros-tate cancer. Foods rich in vitamin C and beta-carotene protect against esophageal cancer. Foods that supply carotenoids, such as dark green and orange vegetables and fruits help protect against cancer of the mouth, pharynx, larynx and lung. Allium vegetables such as garlic, onions and leeks protect against stomach can-cer. Foods that contain dietary fiber protect against colorectal cancer. Nutrients and phytochemicals from plant foods seem to work indepen-dently and synergistically to decrease cancer risk.

Q: What diet advice can you give for cancer prevention?

A: Here are some key points:n Limit consumption of red meat

and avoid consumption of processed meat such as bacon, salami, hot dogs, and sausages.

research shows the importance of proper nutrition in cancer treatment, prevention

Q&A with

Elizabeth Churchill, RDN, CSO, CDN

Registered Dietitian/Nutritionist, Hartford HealthCare Cancer Institute

n Limit alcohol intake to no more than one drink a day for women and two drinks a day for men.n Limit processed foods and foods

high in salt or sodium.n Limit sugary drinks or foods

high in sugar that have little nutri-tional value.n Decrease consumption of

saturated fats and increase intake of omega-3 fatty acids found in olives, olive oils, fatty fish, nuts, avocados and flaxseed.

Q: Can you explain how nutrition can contribute to positive outcomes for patients?

A: I have seen many patients toler-ate their cancer treatments better by focusing on adequate nutritional in-takes during their course of therapy. The goal of Medical Nutrition Therapy (MNT) in cancer patients is to:n Prevent lean muscle massn Prevent or reverse nutri-

ent deficiencies

n Help with better tolerance of treatmentn Minimize nutrition-related side

effects and complicationsn Maximize healing n Maintain strength and energySo, any time we can help a patient

maintain his or her nutritional status during cancer treatment, we can work toward attaining these goals.

Q: If you do a web search on “cancer diets,” you can get an awful lot of information. How do you help patients and family members sort through this sea of “facts”?

A: There is an enormous amount of advice in the media on nutrition and diet plans to help prevent and treat cancer. It can be extremely con-fusing for patients to sort out which advice is actually based in science and which is just someone’s opinion. That’s why, when patients come to me requesting to be put on a specific cancer-related diet, I try to clarify

what they have read about the diet or what someone told them about it and what we actually have scientific evidence for.

Q: Can you give examples of the pluses and minuses of some spe-cific diets?

A: For instance, the ketogenic diet, which is used for children with epi-lepsy, is now being tested in clinical trials for its effectiveness in treating cancer. It is a diet that requires eating 70 percent to 80 percent of your food in the form of fat. This can be very difficult to follow and many of the patients in the trials have dropped out because they could not toler-ate the diet. The alkaline diet has no basis in science. A quote from the American Institute for Cancer Research sums it up: “The proposed mechanism, in which the diet can significantly change the acidity of the blood, goes against everything

See NUTRITION, page 6

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Connecticut adopted a statute legal-izing the use of medical marijuana for

certain types of pa-tients in 2012, and earlier this year, the state opened its first mari-juana dispensaries. Connecticut is one of 23 states across the country, as well as the District of Columbia, to adopt laws for the

legal use of marijuana for patients with chronic health conditions, including can-cer. The Connecticut law allows qualified patients to receive physician-authorized

prescriptions on a monthly basis.Many consider the use of medi-

cal marijuana to be controversial or questionable, as the drug is widely recognized for its recreational use. Yet increasingly, research is showing that marijuana can bring legitimate medi-cal benefits to patients suffering from a variety of ailments.

“Plus” asked Andrew Salner, MD, med-ical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, to share his thoughts on the benefits of medical marijuana for cancer patients.

M edical marijuana may help to control and palliate

symptoms for patients with selected

medical conditions. In particular, it might help to alleviate pain, appetite loss and nausea for selected cancer patients; eye pressure for selected glaucoma patients; seizure frequency and intensity for selected epilepsy patients; and spasticity for selected patients with neurologic conditions — among other possible benefits. In Connecticut, debilitating medi-cal conditions recognized under the state’s medical marijuana statute include: cancer, glaucoma, positive status for Human Immunodeficiency Virus or Acquired Immune Deficiency Syndrome, Parkinson’s Disease, mul-tiple sclerosis, damage to the nervous tissue of the spinal cord with objec-

research suggests marijuana can benefit patients, but lingering questions remaintive neurological indication of intrac-table spasticity, epilepsy, cachexia, wasting syndrome, Crohn’s Disease and Post-Traumatic Stress Disorder.

Connecticut’s marijuana statute is perhaps the most stringent in the country, with provisions requir-ing physician certification that the patient has a qualifying condition, as well as patient registration. The six approved dispensaries in Connecticut require a registered pharmacist to counsel the patient and dispense the appropriate format of the medica-tion. These regulations should help to decrease the risk of fraudulent acquisition of the medication and ensure safe dispensing.

The state selected four growers and six dispensaries following a competi-tive process, and product was finally available for sale in the fall of 2014. Over the next six months, growers will make available different formats (vaporizable liquid, oral and others) and different cannabinoid composi-tions which will benefit patients in different ways and require some personalization for patients in consultation with the dispen- sing pharmacist.

Since medical marijuana is not an FDA-approved drug, and marijuana has been listed as an illegal sub-stance by the federal government, physicians and other providers have

not had the benefit of the usual edu-cational materials that are available when new drugs are released, such as indications, doses, toxicities and side effects, and mechanisms of action.

This dearth of education, along with the stigma of marijuana as an illegal drug, and fear of prosecution, has made many providers reluc-tant to participate in the program. This will gradually change as there is increased experience, increased demand by patients, greater scientific data, and more educational programs available. It clearly will not be a pan-acea for everyone, but it will likely be helpful in selected patients.

Andrew Salner, MD

Hot topics

Q: Broadly speaking, what is the evidence that supports the role of proper nutrition in the care of can-cer patients?

A: Many studies suggest that providing education and resources about nutrition during cancer treat-ment may lead to fewer side effects, fewer hospitalizations and better quality of life. Inadequate manage-ment of side effects and symptoms can result in a decline in a patient’s nutritional status and potentially lead to malnutrition, which has been linked to poorer treatment outcomes.

Q: Is there any evidence that poor or improper nutrition contributes to the incidence of cancer?

A: An estimated one-third of some of the most common cancers and one-quarter of cancer overall could be prevented by healthy pat-terns of diet and physical activity. The American Institute for Cancer Research and the World Cancer

Research Fund developed recom-mendations for cancer prevention that were based on systemic reviews of the literature on food, nutrition, physical activity and cancer.

Q: How can proper nutrition help prevent cancer?

A: The key to a healthy cancer-prevention diet is consuming a predominantly plant-based diet. High consumption of a variety of plant foods protects against cancers at various sites. Plant foods are rich

in phytochemicals, vitamins and minerals. Foods containing selenium and lycopene protect against pros-tate cancer. Foods rich in vitamin C and beta-carotene protect against esophageal cancer. Foods that supply carotenoids, such as dark green and orange vegetables and fruits help protect against cancer of the mouth, pharynx, larynx and lung. Allium vegetables such as garlic, onions and leeks protect against stomach can-cer. Foods that contain dietary fiber protect against colorectal cancer. Nutrients and phytochemicals from plant foods seem to work indepen-dently and synergistically to decrease cancer risk.

Q: What diet advice can you give for cancer prevention?

A: Here are some key points:n Limit consumption of red meat

and avoid consumption of processed meat such as bacon, salami, hot dogs, and sausages.

research shows the importance of proper nutrition in cancer treatment, prevention

Q&A with

Elizabeth Churchill, RDN, CSO, CDN

Registered Dietitian/Nutritionist, Hartford HealthCare Cancer Institute

n Limit alcohol intake to no more than one drink a day for women and two drinks a day for men.n Limit processed foods and foods

high in salt or sodium.n Limit sugary drinks or foods

high in sugar that have little nutri-tional value.n Decrease consumption of

saturated fats and increase intake of omega-3 fatty acids found in olives, olive oils, fatty fish, nuts, avocados and flaxseed.

Q: Can you explain how nutrition can contribute to positive outcomes for patients?

A: I have seen many patients toler-ate their cancer treatments better by focusing on adequate nutritional in-takes during their course of therapy. The goal of Medical Nutrition Therapy (MNT) in cancer patients is to:n Prevent lean muscle massn Prevent or reverse nutri-

ent deficiencies

n Help with better tolerance of treatmentn Minimize nutrition-related side

effects and complicationsn Maximize healing n Maintain strength and energySo, any time we can help a patient

maintain his or her nutritional status during cancer treatment, we can work toward attaining these goals.

Q: If you do a web search on “cancer diets,” you can get an awful lot of information. How do you help patients and family members sort through this sea of “facts”?

A: There is an enormous amount of advice in the media on nutrition and diet plans to help prevent and treat cancer. It can be extremely con-fusing for patients to sort out which advice is actually based in science and which is just someone’s opinion. That’s why, when patients come to me requesting to be put on a specific cancer-related diet, I try to clarify

what they have read about the diet or what someone told them about it and what we actually have scientific evidence for.

Q: Can you give examples of the pluses and minuses of some spe-cific diets?

A: For instance, the ketogenic diet, which is used for children with epi-lepsy, is now being tested in clinical trials for its effectiveness in treating cancer. It is a diet that requires eating 70 percent to 80 percent of your food in the form of fat. This can be very difficult to follow and many of the patients in the trials have dropped out because they could not toler-ate the diet. The alkaline diet has no basis in science. A quote from the American Institute for Cancer Research sums it up: “The proposed mechanism, in which the diet can significantly change the acidity of the blood, goes against everything

See NUTRITION, page 6

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Engine Co. 3 of the Newington Fire Department presented a check for $9,239 to Wendy Lux, fund development director for The Hospital of Central Connecticut (HOCC), to mark the end of the fire company’s “pink truck” campaign to raise money for the new cancer center at HOCC. Last spring, the fire company had one of its trucks wrapped in pink to show its support for breast cancer aware-ness, and the truck appeared at numerous community events throughout the spring, summer and fall. At each of the events, members of the company sold T-shirts, with proceeds going to the new cancer center, which is set to open later this year on the New Britain-Plainville town line. Shown here, from left, are firefighters Tim McDonald, Tim O’Brien, Craig Stegmaier, Wendy Lux of HOCC, Chris Ferri and Austin Muir.

Newington FD’s ‘pink truck’ campaign raises more than $9,000

The road to recovery

Former smoker benefits from early screening — and a dedicated team of physicians

we know about the chemistry of the human body. [It] neglects to recognize that it is ‘virtually impossible’ to create a less acidic environment in the body.” Still, there are some cancer-related diets that can be very healthy and nutritionally complete such as a vegetarian or a vegan diet, or a diet low in refined sugar. If patients want to try these diets, I help them find ways to comply with the diet.

Q: From a dietary standpoint, what are some of the benefits that the Hartford HealthCare Cancer Institute’s membership in the Memorial Sloan Kettering (MSK) Cancer Alliance will bring patients?

A: Our relationship with MSK will allow dietitians and nutri-tionists from both organizations to share standards of practice and best practices to provide the best patient outcomes. We can also share specific protocols for nutri-tion interventions for different cancer types — for example, for individuals with head and neck cancer, who tend have numerous nutrition-related complications during and after treatment. We will be working together in the disease management teams to develop and share our prac-tices so that consistent Medical Nutrition Therapy is provided to all patients.

Elizabeth Churchill, RDN, CSO, CDN, is a registered dietitian/nutritionist who is board-certified as a special-ist in oncology nutrition from the Academy of Nutrition and Dietetics, the world’s largest organization of food and nutrition specialists. She has been an oncology nutrition specialist at the Hartford HealthCare Cancer Institute for more than four years.

NUTRITION from page 5

Ellen Dornelas, PhD, director of quality of life programs for the Hartford HealthCare Cancer Institute (HHCCI), was a featured guest on the Friday, Dec. 5 episode of the popular WNPR radio program, “Where We Live,” hosted by John Dankosky. The show centered around the journey of patients who complete cancer treatment and then strive to recover both emotionally and physically, and how best to meet their needs. Dornelas spoke about the many resources available across HHCCI to help patients resume a full and happy life after treat-ment. A podcast of the program can be heard at http://wnpr.org/post/support-ing-survivors-cancer.

R ichard Caplan smoked a pack of cigarettes a day for more than 30 years, but

quit the habit four years ago after watching his daughter complete the New York City Marathon. Inspired, the 65-year-old Wallingford resident took up running himself, building up to an average of four to five miles ev-ery other day, and discovered that he no longer had an interest in smoking.

But despite his apparent good health, his wife, who is a pallia-tive care provider at The Hospital of Central Connecticut (HOCC), urged him to undergo a free low-dose CT scan lung screening at HOCC, which, as part of Hartford HealthCare, was one of the first hospitals in the state to offer free screenings last year. The screening program was implemented based on findings in the National Lung Screening Trial (NLST) that concluded that screenings are an effective way to detect lung cancer in its early stages.

Caplan, who fit the criteria for the screenings as established by the NLST, was relieved to learn that no cancer had been found in his lungs, but stunned to learn that a large mass had been found on his thymus which would require surgi-cal removal.

After consulting with both his primary care physician and his wife, Caplan made an appointment with surgical oncologist Dr. James Flaherty at HOCC, who told Caplan that the mass could be removed without opening up his chest by using a minimally invasive proce-dure that called for a series of small incisions on the side of his body. The procedure would take about 50 min-utes, Dr. Flaherty estimated.

But as the procedure got under way, Dr. Flaherty discovered that the mass had extended beyond the thy-mus and had wrapped itself around part of Caplan’s heart. So instead

of performing a relatively simple 50-minute procedure, the surgeon spent more than five hours meticu-lously and thoroughly removing the mass from Caplan’s heart.

Once the procedure was complete, Caplan was apprehensive about the possibility of requiring follow-up chemotherapy. But because all traces of the mass were successfully re-moved, he was able to avoid chemo-therapy and underwent an addition-al five weeks of radiation therapy performed by Dr. Neal Goldberg’s radiation oncology team at HOCC.

Caplan is among more than 800 patients who have received free screenings across the Hartford HealthCare Cancer Institute over the past year. He is profoundly grateful for the programs and services that were provided to him.

“I have to say that all of the people who cared for me in this case were extremely impressive,” said Caplan, a social worker. “I always got the sense that everyone was fully com-mitted to helping me get through this in good shape, and that’s what they did.”

I always got the sense that everyone was fully committed to helping me get through this in good shape, and that’s what they did.

— Richard Caplan, Wallingford

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HHC CanCer InstItute at tHe HolIdays

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On the coverOne of the benefits of a physi-cian compact such as the one being drafted for physicians within the Hartford HealthCare Cancer Institute is the oppor-tunity it will provide for closer collaboration among medical staff and other caregivers in various specialties across the Institute. Here, members of the breast cancer disease manage-ment team for HHCCI contrib-ute to a recent discussion on some of the latest advances in research and treatment. From right to left, Diana James, MD; Thomas Banever, MD and Andrew Ricci Jr., MD.

F or the past 17 years, the United

Technologies Corporation (UTC) has donated gifts, money and time to sponsor an an-nual holiday party for pediatric cancer patients at the Hartford HealthCare Cancer Center at Hartford Hospital.

Pediatric cancer patients who have received treatment at the center look forward to the party every year. Highlights include arts and crafts such as face painting, fingernail polishing and origami, as well as holiday food and drink — not to mention a visit from

Santa. Volunteers from the Radiation Oncology Department — including therapists and nurses who treated these patients, along with office staff

— greet the patients and help them with the activities. Toys for all ages are placed under a holiday tree for the patients to choose from. Then the patients get to tell Santa and Mrs. Claus what they want while sitting on their laps.

This year’s party featured a “Polar Express” theme, com-plete with a hot cocoa bar with mini marshmallows, whipped cream, sprinkles and holiday straws along with and

candy bars. While waiting for Santa, patients listened to Rick the Train Conductor read them a story.

staff joins with utC to host party for pediatric patients

Staff members at the Hartford HealthCare Cancer Institute at Hartford Hospital donated numer-ous gifts to adopted families over the holidays. The Cancer Clinical Research Office raised several hundred dollars to buy gifts for a family selected through the Adopt-A-Family Program. Staff members with the donated wrapped gifts shown here are, from left, Anne Clark, Bridgette Boucher, Nicole Sinclair, Susanne Morrill, Tamara Montgomery, Karen Cuddy, Anna Joseph and Oma Ogazi. Not pic-tured is the rest of the staff who also made contributions: Edith Clark, Catherine Enero, Kiran Avancha, Thomas Yakoubian and Jessica Bello. The cancer center’s infusion services team also donated gifts to an adopted family, including a set of bicycles, shown here.

Thomas Lesnik, MD, led a group of carolers and musicians throughout Backus Hospital the week before Christmas as they offered a little holiday cheer to patients and staff. Dr. Lesnik says it’s a tradition he began 40 years ago when he first came to Backus and each year he is joined by staff from surgical services and other departments as well as local musi-cians.

Cancer center teams donate gifts to adopted families

Backus sing-a-long

MSK Cancer Alliance, which was es-tablished to make MSK clinical trials and research protocols to a broader population of patients. This is part of HHCCI’s mission to create a single standard of care across all of the cancer centers within the Institute.

Signing the compact goes hand in hand with the opportunities that will be available as part of HHCCI’s membership in the MSK Cancer Alliance. In fact, the creation of the compact was one of the conditions that HHCCI was asked to meet in or-der to become certified as a member of the MSK alliance.

The compact, which is in the pro-cess of being drafted, will ask physi-cians to make several commitments and adjustments in some of the ways they have traditionally worked with cancer centers and hospitals to provide care for their patients. At the same time, the compact will provide commitments to physicians in terms of resources and relationships.

“The traditional model of pa-tient care in which physicians have operated autonomously or indepen-dently of hospitals or hospital-based caregivers is shifting dramatically,” said Donna Handley, vice president of operations for HHCCI. “As the

largest provider of comprehensive cancer care in our region — and as part of our pioneering partnership with MSK — our Institute needs to quickly and efficiently adapt to these new realities so that patients receive the very best care possible.”

While the compact will ask physi-cians to commit to several adjust-ments in traditional models of care, the document also will outline numerous areas where physicians can expect to receive critical re-sources from the cancer programs across HHCCI as well as MSK, Handley said.

“The compact is a two-way street,” she said. “We realize we are asking physicians to make adjustments and to be adaptable, but we also want them to know we will assist them with the resources they need to make these adjustments successfully.”

The compact is expected to ask commitments of physicians in sev-eral areas, including adopting clini-cal standards of care as established by the disease management teams (DMTs) within the Institute. Other commitments expected to be in the compact include:n Ensuring that the infrastructure

is in place for patients to receive ac-

cess to MSK clinical trialsn Creating a platform and access

to an electronic medical record n Participation in HHCCI confer-

ences, DMTs and goalsBenefits that physicians can ex-

pect under the compact include:n Access to early-phase and novel

clinical research trials, including MSK trialsn Access to nurse navigators to

ensure seamless integration of ex-cellent care for patientsn Branding opportunities as mem-

bers of MSK AlliancePhysician compacts have become

increasingly commonplace in recent years as healthcare organizations adjust to new realities that empha-size value-based outcomes for pa-tients instead of traditional models based on volumes.

One of the main advantages of compacts, Handley said, is that they encourage physicians to become more engaged with the hospitals and healthcare settings where their patients receive care.

The goal is to create a culture in which physicians view their role as a critical part of a multidisciplinary team providing comprehensive, coordinated care to patients.

COMPACTS from page 1

Anca Bulgaru, MD, a medi-cal oncologist at Eastern Connecticut Hematology and Oncology, talks about genetic testing for breast cancer during a special presentation for medi-cal, nursing and oncology support staff. Dr. Bulgaru described the contribu-tion of genetics in breast cancer risk and explained how genetic test results can be used to reduce that risk. The presentation was given at the Hartford HealthCare East Region Support Office in Norwich.

Breast cancer testing

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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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MEMBER

Donna Handley

Vice President of Operations, Hartford HealthCare CancerInstitute

Compacts are good for patients — and physiciansWhen the Hartford HealthCare Cancer Institute

(HHCCI) was formally certified as the charter mem-ber of the Memorial Sloan Kettering (MSK) Cancer Alliance last September, it was clear that our mem-bership in this pioneering alliance would hinge in large part on the willingness and commitment of our medical staff to carry out our vision of clinical integration and affiliation.

Aligning with standards as established by a world-class partner like MSK is good not only for our Institute or the patients who come to us for care — it is also good for our physicians. As enor-mously skilled and accomplished as our physicians are, the opportunity to share and learn with other experts in the field can only help broaden our abil-ity to bring the very best care to patients.

With that in mind, one of the requirements of membership in the alliance is a written compact that our physicians will be asked to sign in order to be considered a part of HHCCI and the MSK Alliance. Such compacts are becoming increas-ingly common at healthcare organizations across

the country due to dramatic shifts in the health-care landscape.

Some physicians have raised concerns that these changes may be detrimental to their profes-sion, but in truth, they signal an opportunity for physicians and organizations to work more closely together. Our goal of eliminating long-standing obstacles to patient care and working collabora-tively to provide coordinated care will be supported through the development of the compact, which we are calling the HHCCI Physician ComPACT. This is an opportunity for physicians to work in a mul-tidisciplinary team-based culture in which their expertise and skills will be put to even better use.

Creating that culture begins with the physician compact, which is why I’m asking our physicians to view the compact for what it is — an opportu-nity to bring enhanced care to patients.

Plus

In this issuen The importance of

nutrition in treating and preventing cancer

n How the state’s medical marijuana laws can benefit patients

n Living to run again: A patient’s story

News from the Hartford HealthCare Cancer Institute

Physician compacts built around a team-based approach to care

A s the Hartford HealthCare Cancer Institute (HHCCI)’s membership in the Memorial

Sloan Kettering (MSK) Cancer Alliance continues to evolve, physicians who practice within the Institute soon will have the opportunity to enter into an agreement that reflects the goals

behind the alliance and outlines the commitment to clinical integration across the Institute.

Anyone who participates in disease management teams and who practices — including Backus Hospital, Hartford Hospital, MidState Medical Center, The Hospital of Central Connecticut and

Windham Hospital — will be asked to sign a physician compact that reflects the changing role that providers are being asked to fill as part of HHCCI and its relationship with MSK.

HHCCI is the charter member of the

See COMPACTS, page 2