WE’RE ALL IN THIS TOGETHER. - Goshen Health...Interdisciplinary cancer care and collaboration are...

THIS TOGETHER.

ALL INWE’RE

C A N C E R P R O G R A M A C H I E V E M E N T S2017-2018

T A B L E O F C O N T E N T S

Mission ..................................................................................................................................................................................................3

Chairman’s Report .................................................................................................................................................................................4

Program Achievements ..........................................................................................................................................................................5

The Cancer Committee .........................................................................................................................................................................6

2017 Facts and Figures ...........................................................................................................................................................................8

Infusion Center Update .......................................................................................................................................................................15

A View from the Other Side of Cancer ...............................................................................................................................................16

Community Outreach: Cervical Cancer Prevention............................................................................................................................18

Research Report Dr. Fornalik ...............................................................................................................................................................20

List of Services & Locations .................................................................................................................................................................23

2 WE’RE ALL IN THIS TOGETHER.

M I S S I O N

The mission of Goshen Health is to improve the

health of our communities by providing innovative,

outstanding care and services through exceptional

people doing exceptional work.

V A L U E S

COMPASSION and commitment to serve with empathy.

ACCOUNTABILITY with integrity and action.

RESPECT through treating others as you with to be treated.

EXCELLENCE in all we do.

3WE’RE ALL IN THIS TOGETHER.

Interdisciplinary cancer care and collaboration are part of our DNA at Goshen Center for Cancer Care at Goshen Hospital. We bring together clinicians from all specialties to discuss the best approach for every case. Whether it’s a difficult, complex case or an early stage, localized one, we believe each patient deserves this personalized level of care. It’s how we limit side effects, improve outcomes and give patients the best experience possible.

More than 1,230 new patients chose our cancer center for diagnosis or treatment in 2017. Nearly one out of four traveled more than 20 miles or out of state for care. We provided specialized care for breast, lung, gastrointestinal and gynecologic cancers as well as other tumor types.

As our case volume expands, we continue to assess ways to ensure our facilities meet current and future patient needs. This thoughtful process led to the opening of the Alice A. and Rex Martin Infusion Center in 2018. Its well-planned, spacious design gives us a better way to provide life-changing therapies, privacy and support at a time when our patients need it most. We are grateful for the generosity of the Rex and Alice A. Martin Foundation in support of this project.

Clinical research has always been a key component of our cancer program. Our active participation in these trials gives patients access to potentially new, life-saving therapies. We continue to refer patients for clinical studies for many types of cancer.

Our collaborative model of care continues to attract board certified, fellowship trained oncologists. These clinicians broaden our integrated program to give referring providers and patients more options for high quality care in one location.

We look forward to continued focus on our mission under the leadership of our new medical director, Leonard Henry, MD, MBA, FACS.

As we approach 2019, we anticipate a highly successful outcome of our upcoming accreditation survey by the Commission on Cancer. This quality program of the American College of Surgeons has always acknowledged excellence in the cancer care we deliver.

In this report, we highlight recent quality data and achievements for Goshen Center for Cancer Care. We also introduce you to patients and their families who bring strength, determination and courage to their challenge with cancer. Their spirit forms a powerful source of energy and healing. It also inspires us to surround them with the resources they need to face each phase of a diagnosis and treatment.

Daniel Bruetman, MD, MMM Chairman, Cancer Committee

C H A I R M A N ’ S R E P O R T



Key quality measures and accreditations place us among the leading cancer centers in our region. Recent highlights include:

• Expansion of our Infusion Center that allows personalized cancer therapies with the latest infusion technology

• Reaccreditation by the American College of Radiology (ACR) for radiation oncology practice

• Extension of our free lung screening program to firefighters who are at higher risk for respiratory disease, including lung cancer

• Introduction of a modified surgical position for high-risk gynecologic patients during robotic surgery

• Consistent achievement of patient satisfaction scores above the 90th percentile


CANCERCOMMITTEE

Helen Sivicek, RN

Clinical Research Coordinator Goshen Center for Cancer Care

Sachin Agarwal, MD

Medical Oncologist Goshen Center for Cancer Care

Rachelle Anthony

American Cancer Society Representative American Cancer Society

Ingrid Bowser, MSN, ANP-BC, AOCNP

Palliative Care Representative Goshen Center for Cancer Care

Beth Otto, CTR, CMA

Cancer Conference Coordinator Goshen Hospital/Center for Cancer Care

James Wheeler, PhD

Radiation Oncologist Goshen Center for Cancer Care

Fiona Denham, MD

Surgical Oncologist & Genetics Professional Goshen Retreat Women’s Health Center

Rita Gingrich, LSCW, OSW-C

Social Worker & Psychosocial Services Coordinator Goshen Center for Cancer Care

Daniel Diener, MD, FACS

Cancer Liaison PhysicianGerig Surgical Services

Susan Franger, MHA

Cancer Program AdministratorGoshen Center for Cancer Care

Tracy Paulus, CTR

Certified Tumor Registrar & Cancer Registry Quality Coordinator

Goshen Hospital/Center for Cancer Care

Juliet Leamon, BSN, RN, NE-BC

Oncology NurseGoshen Hospital

Hollie Carlson, MS, Ed

Community Outreach CoordinatorGoshen Retreat Women’s Health Center

Michael Brendle, MD

Diagnostic RadiologistRadiology Inc.

C O M M I T T E E

RESPONSIBILITIES

• Develop and evaluate the annual goals and objectives for the clinical, educational and programmatic activities related to cancer.

• Promote a coordinated, multidisciplinary approach to patient management.

• Ensure that educational and consultative cancer conferences cover all major sites and related issues.

• Ensure that an active, supportive care system is in place for patients, families and Colleagues.

• Promote clinical research.

• Monitor quality management and improvement through completion of quality management studies that focus on quality, access to care and outcomes.

• Supervise the cancer registry and ensure accurate and timely abstracting, staging and follow-up reporting.

• Perform quality control of registry data.

• Encourage data usage and regular reporting.

• Ensure content of the annual report meets requirements.

• Publish the annual report.

• Uphold medical ethical standards.

Min Yan, MD

Pathologist Goshen Hospital

James Wheeler, PhD

Radiation Oncologist Goshen Center for Cancer Care

Rhonda Griffin, RN, BSN

Quality Improvement Coordinator Goshen Center for Cancer Care

Rita Gingrich, LSCW, OSW-C

Social Worker & Psychosocial Services Coordinator Goshen Center for Cancer Care

Daniel Bruetman, MD, MMM

Cancer Committee Chairman& Medical Oncologist

Goshen Center for Cancer Care


Michael Brendle, MD

Diagnostic RadiologistRadiology Inc.

2017 FACTS AND FIGURESC A N C E R R E G I S T R Y R E P O R T

A detailed abstract for each case of malignant disease seen at our facility, as well as benign brain and related CNS tumors as required, is submitted to the Indiana State Cancer Registry, as well as the National Cancer Database (NCDB). Comparisons are frequently performed to analyze state and national trends and benchmarking statistics. Quality of registry data is paramount. For this reason, quality assurance procedures, periodic audits from the Indiana State Department of Health, and internal quality assurance practices are performed to ensure that Cancer Registry data are complete and accurate.

The Cancer Registry Department at Goshen Hospital/Goshen Center for Cancer Care is a hospital-based cancer information center. Under the guidance of the Clinical Quality and Data Manager, our certified tumor registrars collect, interpret, and record a wide range of demographic, diagnostic, and treatment information on all cancer patients while adhering to all regulations and guidelines set by state and national statutes. Since 2004, the Goshen Cancer Program has been accredited by the American College of Surgeons (ACoS) Commission on Cancer (CoC) and designated as a Community Hospital Comprehensive Cancer Center.

Since our reference year of 1999, there have been over 9,500 patients entered into the cancer registry database. In 2017, a total of 858 cancer cases were added to the database: 775 were analytic cases (diagnosed and/or received first course of treatment at Goshen) and 83 were non-analytic. Approximately 5,000 patients are followed to ensure that continued medical surveillance is being completed. We maintained a follow-up rate of 91.63% on patients diagnosed since our reference year (80% required by the Commission on Cancer) and a follow-up rate of 96.17% for patients diagnosed within the last five years (90% required by the Commission on Cancer). Successful follow-up must be accomplished to determine outcomes of treatment and to provide accurate survival data.


* Goshen Hospital Registry – total patients

** Cancer Facts & Figures 2017, Estimated Numbers of New Cases for Selected Cancers by State, US, 2017 (American Cancer Society, 2017)

NU

MB

ER

OF

PA

TIE

NT

S

200

175

150

125

100

75

50

25

02013 2014 2015

Breast Lung Prostate Colon/Rectum

Melanoma Non-HodgkinLymphoma

Pancreas Uterine

2016 2017

TOP SEVEN SITES

26%

22%

6%

14%

16%

9%

7%

NATIONAL**

Breast 255,180Lung & Bronchus 222,500Uterine 61,380Prostate 161,360Colon & Rectum 135,430Melanoma 87,110NH Lymphoma 72,240

35%

22%

11%

9%

10%

7%6%

GOSHEN HOSPITAL*

Breast 165Lung & Bronchus 107Uterine 52Prostate 50Colon & Rectum 45Melanoma 33NH Lymphoma 28

24%

25%16%

14%

8%

7%

STATE**

Breast 5,140Lung & Bronchus 5,540Uterine 1,370Prostate 3,410Colon & Rectum 3,080Melanoma 1,730NH Lymphoma 1,560

6%

GOSHEN HOSPITAL’S MOST FREQUENT DIAGNOSES (analytic patients only)

St. Joseph2.45%

Other Indiana Counties5.95%

Out-of-State5.80%

Elkhart53.16%

Allen1.03%

LaGrange6.32%

Steuben.90%

Noble4.90%

Kosciusko16.52%

Marshall2.97%

STATE AND COUNTY DISTRIBUTION


P R I M A R Y S I T E T A B L E

Primary Site Total Male Female Analytic Non Analytic 0 I II III IV NA UNK

ORAL CAVITY, PHARYNX 16 13 3 14 2 1 2 0 2 8 1 0

Lip 1 1 0 1 0 0 1 0 0 0 0 0

Tongue 5 3 2 4 1 1 0 0 0 3 0 0

Salivary Gland 1 1 0 1 0 0 0 0 1 0 0 0

Gum, Other Mouth 1 1 0 1 0 0 1 0 0 0 0 0

Tonsil 7 7 0 6 1 0 0 0 1 5 0 0

Other Oral Cavity and Pharynx 1 0 1 1 0 0 0 0 0 0 1 0

DIGESTIVE SYSTEM 164 92 72 150 14 10 28 28 32 50 1 1

Esophagus 10 8 2 9 1 0 1 1 4 3 0 0

Stomach 17 11 6 17 0 0 6 1 2 8 0 0

Small Intestine 3 2 1 2 1 0 0 1 0 1 0 0

Colon, Rectum, Anus 85 46 39 75 10 10 12 15 20 17 0 1

Liver 11 8 3 11 0 0 5 0 1 4 1 0

Gallbladder 1 0 1 1 0 0 0 1 0 0 0 0

Intrahepatic Bile Duct 3 1 2 2 1 0 0 0 0 2 0 0

Other Biliary 5 4 1 5 0 0 1 3 0 1 0 0

Pancreas 25 10 15 24 1 0 3 6 3 12 0 0

Retroperitoneum 2 2 0 2 0 0 0 0 1 1 0 0

Peritoneum, Omentum, Mesentery 2 0 2 2 0 0 0 0 1 1 0 0

RESPIRATORY SYSTEM 126 68 58 117 9 0 27 10 23 52 2 3

Nose 1 1 0 1 0 0 1 0 0 0 0 0

Larynx 10 7 3 8 2 0 1 0 1 6 0 0

Lung and Bronchus - Non-Small Cell 91 46 45 86 5 0 23 9 18 34 0 2

Lung and Bronchus - Small Cell 13 8 5 12 1 0 0 1 3 7 0 1

Lung and Bronchus - Other Lung 10 5 5 9 1 0 2 0 1 5 1 0

Mediastinum, Other Resp. 1 1 0 1 0 0 0 0 0 0 1 0

SOFT TISSUE INCLUDING HEART 4 1 3 4 0 0 0 2 0 1 0 1

SKIN 43 26 17 39 4 3 17 6 3 7 3 0

Skin: Melanoma 36 23 13 33 3 3 15 5 3 7 0 0

Other Non-Epithelial 7 3 4 6 1 0 2 1 0 0 3 0

BREAST 174 0 174 165 9 33 73 38 12 9 0 0


FEMALE GENITAL SYSTEM 97 0 97 85 12 1 44 4 17 9 4 6

Cervix Uteri 14 0 14 11 3 0 5 2 3 1 0 0

Uterus 55 0 55 52 3 0 33 2 8 5 0 4

Ovary 14 0 14 13 1 0 4 0 5 3 0 1

Vagina 3 0 3 2 1 0 0 0 1 0 1 0

Vulva 7 0 7 4 3 1 2 0 0 0 0 1

Other Female Genital Organs 4 0 4 3 1 0 0 0 0 0 3 0

MALE GENITAL SYSTEM 66 66 0 53 13 0 5 29 3 8 0 8

Prostate 63 63 0 50 13 0 5 28 3 8 0 6

Testis 2 2 0 2 0 0 0 1 0 0 0 1

Penis 1 1 0 1 0 0 0 0 0 0 0 1

URINARY SYSTEM 37 30 7 33 4 3 10 6 6 5 0 3

Urinary Bladder 18 17 1 16 2 3 4 2 3 1 0 3

Kidney 17 11 6 15 2 0 6 4 2 3 0 0

Renal Pelvis 1 1 0 1 0 0 0 0 0 1 0 0

Ureter 1 1 0 1 0 0 0 0 1 0 0 0

BRAIN, OTHER NERVOUS SYSTEM 16 8 8 14 2 0 0 0 0 0 14 0

Brain: Malignant 6 4 2 5 1 0 0 0 0 0 5 0

Cranial Nerves, Other Nervous System 1 1 0 0 1 0 0 0 0 0 0 0

Brain-CNS: Benign, Borderline 9 3 6 9 0 0 0 0 0 0 9 0

ENDOCRINE SYSTEM 28 8 20 25 3 0 13 5 1 2 3 1

Thyroid 25 7 18 22 3 0 13 5 1 2 0 1

Adrenal Gland 1 0 1 1 0 0 0 0 0 0 1 0

Endocrine: Benign, Borderline 2 1 1 2 0 0 0 0 0 0 2 0

LYMPHOMA 41 19 22 37 4 0 5 6 14 11 0 1

Hodgkin Nodal 8 4 4 7 1 0 0 4 2 1 0 0

Non-Hodgkin Lymphoma - Nodal 28 13 15 25 3 0 1 2 12 9 0 1

Non-Hodgkin Lymphoma - Extranodal 5 2 3 5 0 0 4 0 0 1 0 0

MYELOMA 7 2 5 6 1 0 0 0 0 0 6 0

LEUKEMIA 24 15 9 20 4 0 0 0 0 0 20 0

Acute Lymphocytic Leukemia 1 1 0 1 0 0 0 0 0 0 1 0

Chronic Lymphocytic Leukemia 13 8 5 11 2 0 0 0 0 0 11 0

Acute Myeloid Leukemia 4 4 0 4 0 0 0 0 0 0 4 0

Acute Monocytic Leukemia 1 1 0 1 0 0 0 0 0 0 1 0

Chronic Myeloid Leukemia 3 1 2 2 1 0 0 0 0 0 2 0

Other Acute Leukemia 1 0 1 1 0 0 0 0 0 0 1 0

Aleukemic, subleukemic and NOS 1 0 1 0 1 0 0 0 0 0 0 0

MESOTHELIOMA 3 2 1 3 0 0 0 0 0 2 0 1

MISCELLANEOUS 12 5 7 10 2 0 0 0 0 0 10 0

TOTALS 858 355 503 775 83 51 224 134 113 164 64 25

GENDER GENDERCLASS OF CASE CLASS OF CASEAJCC STAGING AJCC STAGING


WE’RE ALL INTHIS TOGETHER.

Ebenezer Kio, MD Medical Oncologist, with patient, Karen


FEMALE GENITAL SYSTEM 97 0 97 85 12 1 44 4 17 9 4 6

Cervix Uteri 14 0 14 11 3 0 5 2 3 1 0 0

Uterus 55 0 55 52 3 0 33 2 8 5 0 4

Ovary 14 0 14 13 1 0 4 0 5 3 0 1

Vagina 3 0 3 2 1 0 0 0 1 0 1 0

Vulva 7 0 7 4 3 1 2 0 0 0 0 1

Other Female Genital Organs 4 0 4 3 1 0 0 0 0 0 3 0

MALE GENITAL SYSTEM 66 66 0 53 13 0 5 29 3 8 0 8

Prostate 63 63 0 50 13 0 5 28 3 8 0 6

Testis 2 2 0 2 0 0 0 1 0 0 0 1

Penis 1 1 0 1 0 0 0 0 0 0 0 1

URINARY SYSTEM 37 30 7 33 4 3 10 6 6 5 0 3

Urinary Bladder 18 17 1 16 2 3 4 2 3 1 0 3

Kidney 17 11 6 15 2 0 6 4 2 3 0 0

Renal Pelvis 1 1 0 1 0 0 0 0 0 1 0 0

Ureter 1 1 0 1 0 0 0 0 1 0 0 0

BRAIN, OTHER NERVOUS SYSTEM 16 8 8 14 2 0 0 0 0 0 14 0

Brain: Malignant 6 4 2 5 1 0 0 0 0 0 5 0

Cranial Nerves, Other Nervous System 1 1 0 0 1 0 0 0 0 0 0 0

Brain-CNS: Benign, Borderline 9 3 6 9 0 0 0 0 0 0 9 0

ENDOCRINE SYSTEM 28 8 20 25 3 0 13 5 1 2 3 1

Thyroid 25 7 18 22 3 0 13 5 1 2 0 1

Adrenal Gland 1 0 1 1 0 0 0 0 0 0 1 0

Endocrine: Benign, Borderline 2 1 1 2 0 0 0 0 0 0 2 0

LYMPHOMA 41 19 22 37 4 0 5 6 14 11 0 1

Hodgkin Nodal 8 4 4 7 1 0 0 4 2 1 0 0

Non-Hodgkin Lymphoma - Nodal 28 13 15 25 3 0 1 2 12 9 0 1

Non-Hodgkin Lymphoma - Extranodal 5 2 3 5 0 0 4 0 0 1 0 0

MYELOMA 7 2 5 6 1 0 0 0 0 0 6 0

LEUKEMIA 24 15 9 20 4 0 0 0 0 0 20 0

Acute Lymphocytic Leukemia 1 1 0 1 0 0 0 0 0 0 1 0

Chronic Lymphocytic Leukemia 13 8 5 11 2 0 0 0 0 0 11 0

Acute Myeloid Leukemia 4 4 0 4 0 0 0 0 0 0 4 0

Acute Monocytic Leukemia 1 1 0 1 0 0 0 0 0 0 1 0

Chronic Myeloid Leukemia 3 1 2 2 1 0 0 0 0 0 2 0

Other Acute Leukemia 1 0 1 1 0 0 0 0 0 0 1 0

Aleukemic, subleukemic and NOS 1 0 1 0 1 0 0 0 0 0 0 0

MESOTHELIOMA 3 2 1 3 0 0 0 0 0 2 0 1

MISCELLANEOUS 12 5 7 10 2 0 0 0 0 0 10 0

TOTALS 858 355 503 775 83 51 224 134 113 164 64 25


Alice A. and Rex Martin Infusion Center Opened September 2018

We expanded patient access to personalized cancer therapies with the opening of the Alice A. and Rex Martin Infusion Center in 2018. The new wing enhances privacy, support and care for patients undergoing infusion therapy or injections. It also has increased our capacity by 15% percent.

Large, private bays offer plenty of room for friends and family to lend patient support during infusion sessions. Wide pathways give care teams ample room to guide infusion equipment into place for treatment. Individual comfort controls allow patients to control lighting, sound, temperature and entertainment options in their bays.

Open seven days a week, the center offers outpatient infusion and injection services, including antibiotics, diuretics, transfusions, hydration and supplements. Patients also can receive routine blood work, PICC line care and other phlebotomy services at the center.

Alice A. Martin, Community Philanthropist, Goshen Center for Cancer Care patient

Highlights of the

Alice A. and Rex Martin Infusion Center

• Expanded treatment access with 18 infusion chairs

• Improved privacy for patients, family and caregivers

• Safe, accessible blood work in on-site phlebotomy room

• Patient-centered care though enhanced nursing model

• Enhanced patient support through integrated workspace

U N S U R P A S S E D L E V E L O F C A R E F O R P A T I E N T S I N N E W I N F U S I O N C E N T E R

This support for the infusion center comes from our hearts as personal expressions of gratitude, but also from a deep desire to strengthen the ability of the Goshen Center for Cancer Care to continue to treat others on their cancer journey.

“”


Jeff looked at Goshen Center for Cancer Care with different eyes in March 2018 when he needed treatment himself. While filling in at the center’s Radiation Oncology unit, Jeff saw first-hand the collaborative process that’s a hallmark of the center’s practice model. He participated in weekly tumor boards with other oncologists, nurses, integrative providers and support staff. “I understood the nature of the medical conferencing program,” said Jeff. “I was impressed with how entire team comes together to discuss new patient cases and coordinate treatment plans.” The collaborative approach proved a turning point when he sought a diagnosis for himself.

WHEN THE DOCTOR BECOMES THE PATIENT

Jeff suspected blood he had seen in his stools was a sign of colorectal disease. He had plenty of choices where he could go for diagnosis and treatment. Only Goshen seemed the right fit for him. He knew the oncology team would work together to sequence treatment, based on clinical evidence and outcomes. “Cancer treatment can be very complicated,” explained Radiation Oncologist Houman Vaghefi, MS, MD, PhD. “We bring providers from multiple disciplines together for a cohesive plan of treatment that’s best for the patient.”

Not only does the team discuss the type of cancer and its stage, the group reviews medical data about previous treatments. Providers also consider the patient’s overall health and risk factors. And they discuss the patient’s mental and emotional health. Family support also plays an important role in the discussion. Cancer care today can take several months to complete. A patient may have surgery, followed by months of chemotherapy. Then the patient may go through weeks of radiation. “It takes collaboration not only with the medical team but the patient and family to get through treatment,” said Dr. Vaghefi. “You can have the most sophisticated care in the world, but if patients don’t connect with you or you don’t have families on board, that’s a missed opportunity to deliver the best care.”

Few people see inside as many cancer centers as Jeff Schneider, MD, did before choosing one for his oncology treatment. In the past two decades, the radiation oncologist has walked the hallways of 20 to 30 treatment facilities in more than six states. He travels from center to center as a locum tenens – a physician hired temporarily by a medical center.

HOLISTIC APPROACH CANTERS AROUND THE PATIENT Other cancer centers where Jeff had worked followed a more fragmented delivery of care. Typically, patients traveled from one facility to another for appointments, biopsies, surgeries, infusions, doctor appointments and follow-up care. Jeff appreciated the convenience of going to one location at the Goshen Health campus. As soon as he talked with Dr. Vaghefi about his symptoms, the two brought Surgical Oncologist Leonard Henry, MD, MBA, FACS, into the discussion. They quickly decided Jeff needed a colonoscopy first and scheduled an appointment with Goshen Gastroenterologist Sadat Rashid, MD.

“I was able to schedule my colonoscopy on a Thursday when I was able to take a day off from covering at the clinic,” Jeff said. “That made it convenient for me, since I was already in the area filling in at the Cancer Center.” Biopsy results on polyps were negative. However, the rectal tumor came back positive for adenocarcinoma, a common type of colorectal cancer in the lining of the organ. That’s when Jeff’s team expanded to include Medical Oncologist Daniel Bruetman, MD, MMM.

TREATMENT TAILORED TO THE PATIENT

As the patient, not the doctor, Jeff no longer participated in weekly medical conferences. Yet he was fully involved with decisions about treatment options and sequence of therapies. Part of Jeff’s medical history includes a bout with prostate cancer. In 2003, Jeff chose brachytherapy, a form of internal radiation therapy at a cancer center in Seattle. Oncologists implanted radioactive seeds into the prostate gland. The seeds remain in place permanently, releasing a low level of radiation for several months.

Given his medical history and clinical evidence, Jeff and his team chose an aggressive approach to treat his rectal cancer. The strategy started with a combination of chemotherapy pills and radiation therapy. It placed surgery at the end of the treatment cycle. If the drugs and radiation worked, Jeff could avoid an abdominal perineal resection (APR) to remove his rectum and place a colostomy.16 WE’RE ALL IN THIS TOGETHER.

A V I E W F R O M T H E O T H E R S I D E O F C A N C E R

ONE LOCATION FOR DIAGNOSIS, TREATMENT AND FOLLOW-UP Jeff made the daily hour-an-a-half commute from his home in Fort Wayne to Goshen Center for Cancer Care 33 times. He appreciated the support of his entire cancer team. Nurses were always available to answer his questions. A dietitian explained how combinations of foods, vitamins and probiotics could help with side effects. Jeff used naturopathic medicines on his skin to relieve symptoms from radiation. “The care and quality of support was at the highest level,” he said. “Everyone was attentive to the details and shared what was going on with me.”

Three months after treatment, Jeff had a follow-up MRI and PET CT scan at the Cancer Center that showed no new sites of disease. The diagnostic scans indicated the pelvic lymph node had shrunk and was less intense. Results from an endoscopic ultrasound (EUS) and biopsy a month later showed tumor cells remained in the rectal area. That diagnosis led Jeff’s team to stage a limited resection of the tumor in October. The tumor was resected with negative margins. Follow-up evaluations will determine if Jeff’s pelvic disease is considered to have completely responded to his organ preserving treatment.

“I tell people, based on my experience, Goshen Health is the best place in the state for treatment of cancers they specialize in,” he said. “The care and outcomes are as good or better than anywhere else you could go.”

A MERGER OF CAREER PATHS Oncology wasn’t Jeff’s first choice for a career path. The native of Philadelphia had received a bachelor’s degree in physics from Saint Joseph’s University in his hometown. While working in a cooperative program with General Electric’s Missile and Space Division, Jeff pursued a master’s degree in systems engineering. He worked as an aerospace consultant in Washington, DC, where he met his wife, Sharon, and started a family. That career path didn’t keep his attention for long. With encouragement from Sharon, Jeff followed a different passion – medicine – and started night school to complete his prerequisites.

Eventually, Jeff graduated from the University of Alabama with his Doctor of Medicine. He chose radiation oncology as his specialty and moved his family to New England for a residency at Harvard University. His experience as an oncologist and as a patient with prostate cancer brought Jeff and Sharon to Fort Wayne in 2009. He served as Medical Director of the Prostate Cancer Center, which is owned by Northeast Indiana Urology and part of the Dupont Hospital campus. Jeff also served as Director of the center for three years.

Today, Jeff considers himself semi-retired. He continues to work about a week a month, on average, as a locum doctor. Locum tenens positions take him primarily to centers in Indiana and Massachusetts. He also maintains his medical license in Alabama, Arkansas, Mississippi and New York. When he’s not working, Jeff divides his time between homes in Florida and Fort Wayne. Grandchildren in Birmingham, Ala., Atlanta and New York City also keep him on the move.

Dr. Schneider, Patient at Goshen Center for Cancer Care

The care and outcomes are as good or better than anywhere else you could go. “

”

17

RISK FACTORS FOR CERVICAL CANCER

OUTREACH PROGRAM EFFORTS

COMMUNITY OUTREACHF O C U S E S O N C E R V I C A L C A N C E R P R E V E N T I O N

Each year, we take a close look at our community’s needs for cancer prevention programs. The annual assessment reveals ways we can help people take steps to prevent cancer before it starts.

We chose an initiative in 2018 to raise awareness about a vaccine for HPV, or human papillomavirus, that prevents cervical cancer.

HPV immunization rates in Elkhart County ranked in the bottom 25 percent of state counties, according to a 2017 American Cancer Society assessment. One in five adolescents in the county had received HPV immunization. Statewide, vaccination rates fell below 35 percent in 2017 in an Indiana HPV profile by the Centers for Disease Control and Prevention.

Clinical evidence has clearly established a link between HPV and cervical cancer. Studies show the virus causes virtually all cervical squamous cell cancer cases. Two HPV types (16 and 18) are responsible for 70 percent of all cases.

Nearly 12,000 women in the U.S. receive a diagnosis of invasive cervical cancers each year. A third die from the disease, even with screening and treatment. Thousands more are diagnosed with cervical pre-cancers.

We participated in a local high school athletic event to educate our community about the importance of the HPV vaccine.

• Connected directly with athletes, parents and fans about the HPV vaccine and cancer prevention

• Provided take-away materials with facts about the vaccine and its effectiveness in preventing cancer

• Conducted surveys to gauge awareness about HPV, its connection to cancer and who should get vaccinated

The HPV vaccine is over 97 percent effective at preventing infection, according to the American Cancer Society.

SURVEY RESULTS:


• 100% aware of HPV

• 100% aware of HPV vaccine

• 50% felt well informed

• 100% learned new information

• 44% had child vaccinated

• 44% plan to have child vaccinated

• 4% do not plan to have child vaccinated

• 8% did not respond regarding current or future vaccinations

More than 160 friends and fans attended a girls’ softball game to honor Lizzi in 2018. The game matched Lizzi’s high school alma mater, Penn High School, against crosstown rival Concord High School.

Goshen Center for Cancer Care took part in the event to educate the community on cancer prevention, early detection and screening guidelines.

PREVENTION, DETECTION AND TREATMENT OPTIONS COMMUNITY-BASED PROGRAM SPREADS CANCER PREVENTION EDUCATIONA primary care physician or OB/GYN can help determine if HPV testing or

the HPV vaccine is right for a woman or adolescent.

Treatment options for women with cervical cancer vary, depending on the type and progression of the disease. The gynecology oncology team at Goshen Center for Cancer Care specializes in minimally invasive robotic surgery. Led by Gynecologic Oncologist Hubert Fornalik, MD, FACOG, the team performs 90 percent of major cases robotically, compared to a 65 percent specialty average. Robotic surgeries offer shorter hospital stays and quicker recovery than traditional open surgeries.

An interdisciplinary approach that combines surgery with chemotherapy and radiation offers a unique approach to patients with recurrent cancers. The cancer center has also found that natural therapies and supportive services help improve health and wellbeing throughout a cancer journey.

When found early, precancerous lesions can be treated before they develop into cancer. Cervical cancer also is highly treatable if detected early.

One woman’s crusade to raise awareness about HPV inspired our outreach program in 2018.

Lizzi (Bartosik) Haas knew nothing about HPV in her early 20s. That’s when she first tested positive for the virus. She also did not know her strain of HPV put her at high risk for cervical cancer.

Two months after the birth of her son, doctors diagnosed the 30-year-old with stage 1b1 invasive cervical cancer. She immediately began an aggressive treatment plan at a cancer center in Oregon. Her regimen included external radiation, chemotherapy and internal brachytherapy radiation. Although treatment was working, Lizzi became immunosuppressed from chemotherapy. Her body could not heal from an infection that took her life in 2018.

Lizzi used social media to speak up about HPV and cancer prevention. Her heartfelt message lives on in her 2016 video posted online at HPV16and18.com.

LIZZI’S STORY

It’s important to know about HPV and know if you are at risk for this preventable disease.“ ”Lizzi (Bartosik) Hass

Awareness about HPV and its link to cervical cancer scored high at a community outreach event for Goshen Center for Cancer Care.

19

A DIFFERENT ANGLE TO GYNECOLOGIC SURGERY

High-risk women with cancers in the reproductive system are now candidates for robot-assisted hysterectomies, thanks to a surgical modification introduced at Goshen Center for Cancer Care.

Our gynecologic oncology team uses a 25-degree pelvic tilt for selected obese women during surgery to lower the risk for optic nerve damage. It replaces the standard robotic surgery position, called the Trendelenburg position.

Practice standards recommend surgeons use the Trendelenburg position in robotic surgeries to improve exposure of the pelvic organs. It places the patient up to a 40-degree angle with the pelvis higher than the head.

However, patients with obesity-related comorbidities, including diabetes and glaucoma, are particularly susceptible to intraocular pressure (IOP) fluctuations when they are in an inverted position.

Hubert Fornalik, MD, FACOGGoshen Center for Cancer Care,Board Certified Gynecologic Oncologist

A case demonstration of a robotic hysterectomy and pelvic lymphadenectomy without Trendelenburg position1 concluded that the surgery can be performed safely in selected candidates. The surgery was led by Hubert Fornalik, MD, FACOG, Gynecologic Oncologist at Goshen Center for Cancer Care, with his wife, Physician Assistant Nicole Fornalik, PA-C. It marks the first reported robotic pelvic surgery performed using an alternative angle to the standard approach.

“Robotic surgery allows us to do more precise work in the anatomical area than open surgery,” said Dr. Fornalik. “Surgery may take longer, but we see fewer intraoperative complications. Patients recover faster with a shorter stay in the hospital.”

The case report presented a 76-year old female with grade 2 endometrial cancer. She had a body mass index (BMI) of 36 kg/m2. Her medical history included type 2 diabetes and severe open angle glaucoma. Optic nerve damage had resulted in visual field loss. Her ophthalmologist was concerned that surgery with the traditional Trendelenburg position could lead to further damage and worsening of vision.

“After considering her condition, we decided to proceed with robotic-assisted surgery without the use of Trendelenburg position,” said Nicole Fornalik. “Instead, we used a 25-degree pelvic tilt.”

1 “Robotic hysterectomy and pelvic lymphadenectomy without Trendelenburg position (BMI 36),” Hubert Fornalik, Nicole Fornalik, Goshen Center for Cancer Care, https://www.gynecologiconcology-online.net/article/S0090-8258(17)31549-4/fulltext.

2 “Can Teamwork and High-Volume Experience Overcome Challenges of Lymphadenectomy in Morbidly Obese Patients (Body Mass Index of 40 kg/m2 or Greater) with Endometrial Cancer? Int J Gynecol Cancer. 2018 Jun; 28(5): 959–966.

MODIFIED POSITION LEADS TO UNCOMPLICATED SURGERY

BETTER QUALITY STAGING WITH MINIMALLY INVASIVE SURGICAL APPROACH


Gynecologists widely use robot technology for hysterectomy and malignancy staging. Its advantages include reduced surgical trauma, less post-operative pain, shorter hospital stay and better cosmetic outcome compared to traditional, open surgery.

However, obesity poses substantial surgical risk. Obese patients commonly have comorbid conditions, such as high blood pressure or diabetes, that can complicate intraoperative and postoperative care.2

More than 40 percent of women in the U.S. are considered obese with a BMI ≥30 kg/m2. Nearly 10 percent are extremely obese with BMI ≥40 kg/m2.

A broad group of cancers affect a woman’s reproductive organs, called gynecologic cancer. Types of cancers include cervical, ovarian, uterine, vaginal and vulvar cancer. No woman is without risk, and a woman’s risk increases with age.

Nearly 100,000 new cases of these cancers are diagnosed each year. Approximately 30,000 women will die of one of these cancers.

Goshen Center for Cancer Care offers a full range of treatment options for gynecologic cancer, including surgery, chemotherapy and radiation.

Gynecologic Oncologist Hubert Fornalik, MD, FACOG, leads the gynecologic program at Goshen Center for Cancer Care. He specializes in robotic-assisted surgery for tumor removal and other benign gynecological conditions.

Dr. Fornalik performs 90 percent of his major cases robotically, compared to an average among specialists of 65 percent.

The fellowship-trained gynecologic oncologist has focused his clinical and research interests on the effects of obesity on prognosis and surgical outcomes. As part of his research in new robotic-assisted surgical approaches, he has introduced the first report of robotic hand-assisted surgery to stage ovarian and high-risk uterine cancers.

GYNECOLOGIC ONCOLOGYRobotic-assisted surgery part of interdisciplinary approach

Hubert Fornalik and Nicole Fornalik with the Da Vinci Si HD Surgical System


TEAMWORK APPROACH FORMS CORNERSTONE OF TECHNIQUE

The conclusion of the case demonstration identified key factors that affect outcomes. They include an experienced team, use of modifications, two bedside assistants and the pelvic tilt.

“The case was considered difficult even for our experienced team,” said Nicole Fornalik.

Dr. Fornalik had performed more than 1,100 robotic surgery cases. Nicole Fornalik had assisted with more than 1,300 robotic cases. The certified surgical first assistant had performed more than 100 robotic cases.

Other studies led by Dr. Fornalik have demonstrated favorable outcomes for morbidly obese patients who undergo robotic surgeries3. Results rely on surgeries at centers with high-volume surgeons and a multidisciplinary approach, according to the authors. A skilled team of professionals can troubleshoot complex and overlapping problems and implement remedial strategies.

“”Hubert Fornalik, MD, FACOG

Referring high-risk surgeries to centers that specialize in robotic surgeries improves outcomes. We are pleased to bring this practice to our community to provide better care for our patients.

3 Ibid. Int J Gynecol Cancer. 2018 Jun; 28(5): 959–966.

200 High Park Drive, Goshen, IN (South of Goshen Hospital’s main entrance)GoshenCancerCare.org | (888) 492-HOPE

Services available at our primary facility: • Medical oncology • Surgical oncology • Radiation oncology • Integrative therapies • Cancer screenings • Support regimens • Educational services

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Services available at our primary facility: • Medical oncology • Consultations • Chemotherapy infusions (low to moderate risk) • Support regimens • Educational services

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Services available at our primary facility: • Diagnostic services • Cancer services • High risk breast cancer program • Naturopathic consultation • Educational services

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