Beating cancer demands the extraordinary Annual Report 2018
Hillary Piniaz, a 31-year-old elementary school teacher and breast cancer survivor, underwent six rounds of chemotherapy. She worked with her Baptist MD Anderson Cancer Center team to preserve her hair with a special scalp-cooling cap. “Everyone I talked to about their cancer treatment told me losing their hair was the hardest part,” Piniaz said. “My cancer is gone, and I still feel like myself.”
Program Milestones 2014–2018
Final beams placed on the new cancer center building Through MD Anderson’s partnership with PGA TOUR, community skin cancer screening at THE PLAYERS Championship – 73 individuals screened
This timeline shows a few of Baptist MD Anderson’s milestones since the partnership between Baptist Health and MD Anderson Cancer Center formed in 2014. Each milestone reflects the work of a dedicated Baptist MD Anderson community working together in the local and regional fight to eliminate cancer.
Enhanced Recovery After Surgery (ERAS) protocols started in colorectal and thoracic surgery programs 5,559 patients treated, including 3,342 analytic cases and 2,217 non-analytic cases*† 1,485 individuals screened for lung cancer
Partnership forms between Baptist Health and MD Anderson Cancer Center to establish Baptist MD Anderson
Baptist MD Anderson opens its doors to the first patients in a renovated 100,000-square-foot outpatient facility
Groundbreaking on a new destination cancer center designed around the MD Anderson model of care
Baptist MD Anderson Medical Director Bill Putnam, MD, named as vice chair of the American Board of Thoracic Surgery Baptist MD Anderson accredited by the National Accreditation Program for Breast Centers
Community skin cancer screening at THE PLAYERS Championship – 133 individuals screened Baptist MD Anderson at Baptist Medical Center South opens, providing radiation oncology, medical oncology and infusion services Surgical oncologist performs Baptist MD Anderson’s first transoral robotic pharyngectomy New, nine-story, 330,000-square-foot cancer center opens, accepting patients from throughout the Southeast U.S.
5,859 patients** treated, including 2,537 analytic cases and 1,857 non-analytic cases† American College of Surgeons Commission on Cancer – Comprehensive Community Cancer Center Designation American College of Radiology accredits Baptist MD Anderson with a Lung Cancer Screening Center Designation – 1,872 individuals screened for lung cancer
More than 600 artworks selected to create an arts-enriched healing environment in the new cancer center
*Reporting based on January-December calendar year. **Annualized for the full calendar reporting year based on January – May 2018 data. †Analytic cases represent patients who were diagnosed or received their first course of treatment. Non-analytic cases refer to patients who sought a second opinion, or transferred their care.
Table of Contents 5 | Message from the Medical Director 6 | Message from the Vice President 8 | Integration by design 12 | Clinical outcomes
28 | Message from the Head of Cancer Medicine 31 | Enhanced Recovery After Surgery (ERAS) 33 | Donors
18 | Message from the Surgeon-in-Chief 22 | Message from Neuro-Oncology Leadership 26 | Beating the odds against brain cancer
Message from the Medical Director Let me extend a warm welcome to our patients, families and colleagues from our new Baptist MD Anderson Cancer Center. These past few years have transformed our ability to move forward with our mission of providing patient-centered care to patients in North Florida and the region. We are proud of the partnership formed in 2014 between MD Anderson Cancer Center and Baptist Health – a distinction shared with only six other cancer programs in the nation. This relationship pairs our program with the country’s No. 1-ranked cancer hospital. By replicating the approach to care pioneered by MD Anderson, we provide adult patients with access to the same leading-edge treatment options as one of the world’s most respected cancer centers. Another milestone occurred in September 2018, when our flagship Baptist MD Anderson facility opened. Planned with a commitment to provide respectful, timely and expert care, our facility provides cancer diagnosis, staging, treatment and wellness in one location, and under one roof. We can reduce the need for patients to coordinate care with myriad providers across multiple locations.
There are many reasons to be hopeful for the future of Baptist MD Anderson. This is a transformational time for innovative cancer care – for example, using the body’s immune system to attack cancer directly, providing less radiation with equal or better outcomes, and helping patients to recover faster and reduce their need for narcotic pain medications. We have been warmly welcomed by our extended Jacksonville community – thank you! On behalf of our physicians, nurses, advanced practice providers, and many talented team members, we extend our deepest appreciation to all who have supported and continue to support our shared mission of Making Cancer History! Very sincerely,
Joe B. “Bill” Putnam, Jr., MD, FACS
Message from the Vice President Cancer is a single word that significantly impacts the lives of the people it touches! It does not discriminate who it chooses or when it shows up. The implications of cancer are complex and life changing. How it affects one person will be different from how it impacts another. That is why Baptist MD Anderson focuses on cancer. This focus drives everything we do and determines how we care for our patients. We develop individualized care plans with physical, spiritual and family needs in mind. Patients are connected with specially trained nurses and nurse navigators who shepherd them throughout their cancer journey. Our support services include nutrition, rehabilitation and occupational medicine, social work, genetics counseling, the healing arts and spiritual care. Understanding the importance of wellness in the cancer journey is equally important to the treatment of the disease itself. Baptist MD Andersonâ€™s Life Wellness Center provides specialty care in addition to wellness products and services.
Our certified mastectomy fitter plays a special role with women who have undergone breast surgery by helping them to choose the right post-treatment supplies and offering compassionate support. For those who experience hair loss during treatment, complimentary scalp treatments and wig fittings are also available. By offering a range of supportive services and resources, we complement the science of our expert doctors to heal the entire person, not just their cancer. Supportive services also help family and friends who are facing cancer alongside a loved one by providing an opportunity to ask questions, share concerns, seek information and relate their experiences. No one should face cancer alone. Together, we provide support and tools to help patients live as fully as possible. Thank your for the privilege of serving the community,
LeeAnn Mengel, BSN, MBA
Integration by design
Modern medicine encompasses much more than the coordination and integration of care – it’s about treating a patient from the inside out. That means providing emotional support, involving friends and family in a treatment plan, respecting a patient’s values, taking into account their physical comfort, and allowing for care continuity and secure transitions between health care settings. At Baptist MD Anderson, these principles provide the framework for designing care to best meet the needs of each and every patient. We raised our commitment to top-quality cancer care with the September 2018 opening of our 330,000-sq.-ft., nine-story facility. “The new Baptist MD Anderson facility serves as a beacon of hope to adult patients and their families facing a devastating disease that has touched all of us at some point in our lives,” said Hugh Greene, president and CEO of Baptist Health. “In Northeast Florida alone, more than 7,000 people are diagnosed each year with cancer, which is the leading cause of death in our region.”
The Baptist Health Board of Directors was instrumental in directing the project team to develop a facility that worked within multiple contexts: bold enough to serve as an iconic structure amid the urban landscape of downtown Jacksonville and I-95, yet compatible with the surrounding historic neighborhood.
An abundance of light, grand staircase and soaring ceiling provides a welcoming environment.
To create a truly responsive cancer care environment, the design team considered the unique needs of individuals who inhabit it – patients, caregivers and team members alike. The facility design reflects the team-based model of care pioneered by MD Anderson, which brings together the subspecialty experts who focus on each specific cancer type. Baptist MD Anderson is organized into 10 cancer clinics, co-locating the patient’s care team to ensure services are integrated and efficient. Dedicated cancer nurse navigators are an essential part of the team, providing answers to patient and family questions and coordinating next steps in care. “To have radiation oncologists, medical oncologists, surgeons, diagnostic imaging, procedure rooms, a laboratory, a pharmacy specifically for chemotherapy drugs, and a state-of-the-art infusion center is very special and very unusual,” said Medical Director Bill Putnam, MD. “Physicians are no more than a few feet away from the nurses or the patients whenever the need arises.”
To create a truly responsive cancer care environment, the design team considered the unique needs of individuals who inhabit it â€“ patients, caregivers and team members alike.
Baptist MD Anderson aims to deliver innovative, effective care that is customized to each patient â€“ whether thatâ€™s through surgery, medical treatments, enhancing the immune system, or providing targeted radiation therapy. A key feature of our innovative care is the collaborative focus on the holistic needs of the patient, which is enhanced by convenient, on-site wraparound supportive services. Careful thought was put into patient and family amenities, including the creation of a spacious family lounge with kitchen, which is especially appreciated by those traveling to Baptist MD Anderson from out of the area. The new facility also features a wellness center dedicated to the needs of cancer patients as well as a cancer-specialized Walgreens pharmacy led by pharmacists and pharmacy technicians who have special training in preparing cancer treatment drugs.
To help create an uplifting, healing environment, original art is integrated wherever a patient, caregiver or team member travels throughout the facility. Baptist MD Anderson’s Art Advisory Committee engaged patients, art professionals and the facility design team in the development of a healing art collection which features more than 600 works of art in a variety of mediums, styles and techniques. Rather than serving only as décor, the works of art are considered integral to providing a source of comfort and a positive distraction helping to reduce anxiety and stress.
Baptist MD Anderson at Baptist South In 2018, Baptist MD Anderson opened a second location at Baptist Medical Center South. Located at I-95 and Old St. Augustine Road, this new location offers radiation oncology, medical oncology and infusion services in an environment that is both comfortable and convenient for patients in southern Duval and northern St. Johns counties.
While the center’s artwork, design and functionality all play important roles in delivering the best possible patient and family experience, ultimately, what sets Baptist MD Anderson apart is its people. “This building is a reflection of the amazing people inside it,” said LeeAnn Mengel, Baptist MD Anderson vice president. “Everyone who works here goes through special cancer care training. From the moment you call our center, you’re met with an understanding voice. Our team gets close to these patients and we want them to know there is life after cancer.”
Using nurse navigators to improve the quality of cancer care Baptist MD Anderson is accredited by the Commission on Cancer (CoC) and the National Accreditation Program for Breast Centers. These accreditation programs ensure health care providers offer the latest in evidence- based care and raise cancer awareness in the community. Baptist MD Anderson developed its cancer program based on the high standards of these accrediting bodies, our community’s needs and national best practices.
Baptist MD Anderson strives to improve the survival and quality of life for cancer patients by establishing prevention, education, research and quality of care standards.
At Baptist MD Anderson, our nurse
As a result of the 2016 CNA, the Cancer Committee identified CoC Standard 4.8 “Quality Improvements” as an opportunity to enhance the cancer navigation process throughout a patient’s care experience.
navigators are there for patients every step of the way, guiding them throughout their cancer journey.
Each year, our Cancer Committee develops and disseminates a Community Needs Assessment (CNA) that addresses health care disparities and barriers to cancer care.
Cancer nurse navigators support the continuum of care for patients with cancer, from pre-diagnosis throughout the patient’s journey to survivorship. (Continued on page 15)
Physical therapist Agnes Winter specializes in lymphedema therapy and is part of Baptist MD Andersonâ€™s supportive services team. BaptistMDAnderson.com
At Baptist MD Anderson, the role of the nurse navigator includes: Navigation • Serving as a liaison between patients, doctors, hospital staff and clinical departments to facilitate a patient’s care • Facilitating multidisciplinary meetings to discuss a case • Promoting participation in clinical trials • Assessing the needs of patients, families and caregivers • Meeting patients’ unmet needs with appropriate support services and referrals as appropriate Education • Providing education to patients, families and caregivers, orienting them to the health system and explaining multidisciplinary team member roles Wellness • Maintaining follow-up with patients while at home to provide educational support and comfort to ensure recommendations are followed • Promoting healthy lifestyle choices and self-care strategies through education and appropriate referrals to supportive services
Investment in cancer nurse navigators at Baptist MD Anderson: Over the past three years, Baptist MD Anderson has made a meaningful investment in our nurse navigator program, providing optimal care to patients. • 2016: nine nurse navigators • 2017: eleven nurse navigators • 2018: twelve nurse navigators and a nurse manager
In 2018, Baptist MD Anderson partnered with internal and external resources to reduce health care disparities by enhancing the cancer nurse navigator process. Improvements include: • Development and implementation of a new cancer navigation policy to include the specific Standardized Navigation Metrics published by the Academy of Oncology Nurse & Patient Navigation • Development of “The Role of the Nurse Navigator,” to educate patients on how their nurse navigator can support them through each phase of care and treatment • Implementation of a new internal Baptist MD Anderson team contact list for care providers to assist in the timely facilitation of the patient navigation process They help improve timely access to cancer care, starting with the first patient interaction when patients are given a cancer care resource binder that includes information that they’ll need throughout their treatment. The nurse navigators show patients how to use the binder to keep track of test results, medications, symptoms, appointments, treatments and resources.
• Facilitation of ongoing education sessions with nurse navigators to incorporate Standardized Navigation Metrics into patient care plans
Nurse Navigation Team
Priscilla Horton, RN, BSN Clinical Nurse Manager
Carolyn Baggett, RN, BSN, BPM Lung Screening Nurse Navigator
Dee Baker, RN, OCN Head and Neck Cancer Nurse Navigator
Kate Brannick, RN, BSN Survivorship Nurse Navigator
Laveda Carter, RN Breast Cancer Nurse Navigator
Candy Childress, RN, BSN Gastroenterological Cancer Nurse Navigator
Clinical trials at Baptist MD Anderson Through a partnership with MD Anderson Cancer Center in Houston, Baptist MD Anderson offers patients access to novel treatments and new technology through participation in select clinical trials. These trials will help shape the future of cancer care for all patients. Building on a more than 20-year foundation of clinical trials at Baptist Health, the Baptist MD Anderson Clinical Trials Office focuses on clinical trials for adult cancer patients. We offer select clinical trials with MD Anderson, as well as multiple unique clinical trials from leading pharmaceutical companies, the National Cancer Institute, National Clinical Trials Network, private sector companies and individual physician investigators. 16
Marcelle Marie, RN Cancer Nurse Navigator
Michele Mayerlen, RN Gynecological Cancer Nurse Navigator
Peggy Neville, MSN, RN, CBCN Breast Cancer Nurse Navigator
Patrick Regis, MSN, APRN, FNP-BC Neuro-Oncology Nurse Navigator
Rad Welch, RN, MSN, BSH Lung Cancer Nurse Navigator
Rassy Sprouse Navigation Coordinator
Eliminating surgery in breast cancer patients who are exceptional responders In partnership with MD Anderson, we are offering a groundbreaking breast cancer clinical trial, “Eliminating Breast Cancer Surgery in Exceptional Responders with Neoadjuvant Systemic Therapy,” to investigate whether breast cancer surgery can be eliminated in selective patients who have been identified as “exceptional responders” after achieving pathologic complete response (pCR) following chemotherapy treatments.
The goal of this study is to learn how often breast cancer returns in patients who have been treated with chemotherapy and radiation therapy, but not surgery, and are in complete remission. Ultimately, researchers will be able to determine whether surgery can be avoided in breast cancer patient identified as “exceptional responders.”
In the study, radiation therapy is delivered to women who are at low risk for local recurrence after chemotherapy, making them strong candidates for less invasive treatment options.
Christopher M. Pezzi, MD, FACS Surgeon-in-Chief and Head, Division of Surgery
MESSAGE FROM THE SURGEON-IN-CHIEF
Advancing oncologic surgery with a growing team and a multidisciplinary approach The Division of Surgery’s mission is to bring expertise in advanced oncologic surgery – for both common and rare cancers of all types – to Northeast Florida and the region. By replicating the proven MD Anderson model, Baptist MD Anderson emphasizes true team collaboration to ensure the safest, most appropriate, individualized, multidisciplinary treatment is offered and delivered to every patient.
In 2018, the division grew to 21 surgeons in 10 sections: • Breast Surgical Oncology • Colorectal Surgery • Complex General Surgical Oncology • Gynecologic Oncology • Head and Neck Surgical Oncology • Neurosurgical Oncology • Orthopedic Oncology and Musculoskeletal Tumors • Plastic and Reconstructive Surgery • Thoracic Surgery • Urologic Oncology Multiple top-quality surgeons joined Baptist MD Anderson over the past year; five of these physicians and their specialties are highlighted on the following pages.
The Baptist MD Anderson Division of Surgery team is committed to offering people with cancer a safe, state-of-the-art experience and a rapid recovery when surgery is part of their individualized treatment plan. Our surgeons bring their highly specialized skills to treat all stages and types of cancers, often using minimally invasive techniques to deliver optimal patient care and outcomes.
Bedford Hudson (“Hud”) Berrey, Jr., MD, joined Baptist MD Anderson with extensive experience in the treatment of sarcomas and all primary and secondary malignant tumors of bone and soft tissues as well as complex orthopedic issues. Dr. Berry trained at Tripler Army Medical Center and Massachusetts General Hospital. He previously served as the chief of Orthopedic Surgery and director of the Orthopedic Residency Program at Walter Reed Army Medical Center in Washington, D.C., chair of the Department of Orthopedics and Rehabilitation and director of the Orthopedic Residency Program at the University of Florida, Jacksonville, where he was also appointed chief of Sarcoma and Musculoskeletal Oncology.
Ron Landmann, MD, FACS, brought his national reputation as a leader in colorectal cancer robotic surgery to Baptist MD Anderson, with strengths academically in clinical research, patient care and education. Having trained at Columbia University, Memorial Sloan-Kettering Cancer Center, Cornell University and Cleveland Clinic Florida, Dr. Landmann previously practiced as a consultant in Colon and Rectal Surgery at Mayo Clinic and as a consultant surgeon at Wolfson Children’s Hospital. Dr. Landmann is currently contributing to the writing of standards for the accreditation process for Rectal Cancer Centers of Excellence across the U.S.
Jonathan Melquist, MD, completed his Urologic Oncology Fellowship at the MD Anderson Cancer Center in Houston before spending three years in Tallahassee as a clinical assistant professor at Florida State University. While a fellow at MD Anderson, Dr. Melquistâ€™s research projects examined molecular sub-setting of advanced stage bladder cancer, a novel transcription factor in bladder cancer metastasis, and bladder cancer prediction models. Dr. Melquist specializes in the care of patients with cancers of the kidney, bladder and prostate in collaboration with the multidisciplinary team including radiation oncology and medical oncology.
Russell Smith, MD, FACS, came to Jacksonville from Creighton University and the University of Nebraska, where he served as a nationally respected professor of Head and Neck Surgical Oncology. At Baptist MD Anderson, Dr. Smith is building a program that offers the highest level of surgical care to treat patients with cancers of the oral cavity, pharynx, larynx, nose and sinuses, and tumors of the skin, skull base, salivary glands, thyroid gland, parathyroid glands, and soft tissues of the neck. The American Academy of Otolaryngology recognized Dr. Smith with the Head and Neck Distinguished Service Award in 2016.
Laila Samiian, MD, FACS, joined Baptist MD Anderson in Breast Surgical Oncology from the University of Florida College of Medicine in Jacksonville, where she served as chief for the Section of Breast Surgery and as an assistant professor of surgery. Dr. Samiian completed her fellowship training at Stanford University and has been awarded multiple honors, including Exemplary Teacher Awards from the University of Florida College of Medicine in 2016 and 2017, and an Honored Care Giver Award in 2017.
Mike Olson, MD, PhD Head Ad Interim, Division of Radiation Oncology Robert Cavaliere, MD Neuro-Oncology 22
MESSAGE FROM NEURO-ONCOLOGY LEADERSHIP
Expanding and advancing the care of patients with malignant brain tumors Malignant brain tumors are among the most challenging to treat and require true multidisciplinary expertise, planning and coordination. Fellowship-trained subspecialists within NeuroRadiology, Neuropathology, Neurosurgery, Neuro-Oncology and Radiation Oncology actively collaborate to deliver the most advanced care to patients with brain tumors.
Multidisciplinary conferences and clinic The co-location of multiple specialties in the new Baptist MD Anderson facility promotes a multidisciplinary partnership in program development and patient care. In addition, routinely scheduled forums enhance multidisciplinary collaboration: • Neuro-Oncology conference is where the team gathers to review imaging and pathology on new cases and consider additional options on established patients • Monthly quality control rounds incorporate nursing and Neuro-Intensive Care Unit expertise in the review of index
cases in an effort to improve care pathways, outcomes and patient satisfaction • Neuro-Radiology rounds provide an additional venue for timely multidisciplinary review of complex cases and serve as a forum to assess and update imaging pathways and technology • Multidisciplinary Clinic brings together Neurosurgery, Radiation Medicine and Neuro-Oncology in a single location to facilitate efficient patient data evaluation and treatment plan formulation – This collaborative process enhances patient convenience, as patients no longer need to be seen at myriad locations and times – Throughout the program, nursing navigators guide patients through the process to promote continuity of care, answer their questions and provide a more satisfying patient experience
Specialized equipment and software
In 2018, Neuro-Radiology implemented the Nordic NeuroLab and upgraded our BrainLab server and software. These changes significantly enhanced tractography (see Figure 1) and functional and perfusion imaging, thereby allowing neurosurgeons to safely and more completely resect tumors. Routine use of the BrainLab ExacTrac system allows Radiation Medicine to rapidly and accurately treat brain tumors, maximizing efficacy while minimizing toxicity. Neuropathology routinely incorporates the latest molecular genetic data to facilitate personalized delivery of therapy to patients.
At Baptist MD Anderson, clinical trials focusing on primary and secondary tumors of the central nervous system are a priority. Our Neuro-Oncology program is the leading accrual site to EAF151, a national study of perfusion MRI in patients with recurrent glioblastoma on bevacizumab, a cancer treatment drug. Our program also has one of the highest enrollment rates in the NeMeRe registry, an international, prospective registry of patients with neoplastic meningitis aimed at better understanding a serious problem in which cancer cells spread from the primary brain tumor to the meninges, or thin layers of tissue that protect the brain and spinal cord. In 2019, we will continue to partner with leading academic programs to bring the latest research and novel treatments to our patients.
Figure 1: Baptist MD Anderson has significantly enhanced tractography.
Programmatic development and future goals Taking a dedicated service line approach involves incorporating input from committed subspecialty experts and fostering a collective vision of program growth and development. In doing so, services are integrated into each other rather than simply co-existing, creating true multidisciplinary care. Service line planning allows prioritization of program initiatives that serve the program as a whole.
In 2019, we plan to: • Formalize collaborations with other leading brain tumor centers • Expand our clinical trial portfolio • Investigate new surgical approaches (i.e., Laser Interstitial Thermoablative Therapy) • Establish our skull base and spine programs
Figure 2: Gliomas diagnosed at Baptist MD Anderson from January 2016 through September 2018.
Spotlight on Glioblastomas Glioblastoma multiforme (GBM) is the most common and deadliest of malignant primary brain tumors in adults and is one of a group of tumors referred to as gliomas (see Figure 2). Since 2016, Baptist MD Anderson has treated 150 newly diagnosed gliomas, of which 109 were glioblastoma. Among patients with GBM, the average age was 65-years-old with 10 percent of cases occurring in a non-white population, which is consistent with national averages. Because the follow-up time period is short, there is limited ability to meaningfully interpret outcomes data.
n Glioblastoma, 110 n Anaplastic astrocytoma, 23 n Astrocytoma, 12 n Anaplastic oligodendroglioma, 3 n Oligodendroglioma, 4
NEURO-ONCOLOGY PATIENT STORY
Beating the odds against brain cancer Marvin Gaye crooned from a portable radio as Travis Martin danced in his hospital room. You’d never imagine that he was on a dedicated Baptist MD Anderson Cancer Center unit.
For more than a year, Martin wondered what was wrong with him. His vision suffered, he felt tired all the time, and he lost his carefree outlook on life.
With a grin, he playfully hip bumped his nurse, egging her to join. Instead, she laughed and called Martin the unit’s “Troublemaker.”
While driving with his fiancé, he’d ask her where she lived – and she’d calmly reply, “With you, of course.” Or, as Martin took his stepson to school, he’d ask, “Where’s the salt and pepper shaker?”
“Your blood pressure is going to be elevated if you don’t stop,” she told him. By the end of the day, she wasn’t be the only one to affectionately give him the nickname. Everyone seemed to know when Martin was in the hospital – either because of his music or his aromatherapy diffuser or his upbeat personality. When visitors arrived, the 33-year-old wasted no time in introducing himself. “Hi, I’m Travis. I have stage 4 brain cancer,” he told visitors. Central nervous system lymphoma, to be exact, which is rarely found in a patient so young. “It looked unusual on the MRI,” said neuro-oncologist Robert Cavaliere, MD. “He was the wrong demographic. Everything worked against him in terms of getting the right diagnosis.”
Recognizing his family’s confusion, Martin reflected on how he felt in those moments. “Oh, you’re an idiot. Why do you keep asking these stupid questions?” he’d ask himself. Despite his declining health, Martin married and drove to Orlando with his wife to celebrate what should have been one of their happiest moments. Orlando, however, was a turning point in his disease’s progression. At the hotel, Martin attempted to climb into the pool, but could hardly stand. He stumbled from person to person, using young swimmers as support. People complained he was too drunk, but his wife told them, “He’s not drunk. He’s sick.”
The two left Orlando and Martin promptly went to the Baptist Medical Center Jacksonville Emergency Center. That’s when things suddenly started to make sense. Doctors performed an emergency craniotomy to diagnose Martin, and the biopsy confirmed he had central nervous system lymphoma. “Now, we could put a name to it, and the name was cancer,” Martin said. “I don’t think anyone takes that term lightly.” By the time his diagnosis came back, Martin was dying. His white blood cell count was astronomical, and his fever spiked to 106 degrees. Dr. Cavaliere recommended a high dose of chemotherapy. “We were desperate,” he said. “It’s a high dose, but we were so desperate that first day because he was progressively getting worse and worse.” As it turned out, Martin’s body handled the chemo very well – and has continued to do so in the seven rounds he’s had since. “He’s a true save,” Dr. Cavaliere said. “The guy came in comatose, and now he’s normal. It’s a delightful outcome.”
Travis Martin Neuro-Oncology cancer survivor BaptistMDAnderson.com
MESSAGE FROM THE HEAD OF CANCER MEDICINE
Hematologic malignancies: Rare cancers need doctors who treat rare stuff Lymphomas, multiple myeloma and leukemias are rare forms of blood cancers. The estimated number of new cases of non-Hodgkinâ€™s lymphoma and leukemia are five percent and four percent for men, and four percent and three percent for women, respectively. Multiple myeloma and Hodgkinâ€™s lymphoma account for less than one percent of all newly diagnosed cancer cases. In contrast, prostate cancer, lung cancer and colon cancer comprise roughly 40 percent of all new cancer cases for men, while breast cancer, lung cancer and colon cancer make up approximately 50 percent of all new cancer diagnoses for women. The sequencing of the human genome (The Human Genome Project) led to rapid development of our understanding of the molecular basis of cancer. The identification of molecular cancer targets used for molecular testing, genetic screening, cancer prevention, oncogenomics and pharmacogenomics ushered in the new era of personalized cancer medicine. Subsequently, the FDA continues to approve new or expanded indications for all cancer subtypes. For example,
there are more than 30 drugs approved for patients with multiple myeloma. While it is exciting to have many therapeutic options for patients, it is difficult to know how to sequence such therapy and manage any subsequent toxicity without an astute understanding of the underlying disease. Intuitively, we as clinicians know that clinical experience matters when complex treatment is required. In light of the ever-growing mass of information that is available to the oncology community, it only makes sense that a diseasespecific clinician is most capable of managing a specific cancer, especially a rare cancer. For example, patients with chronic lymphocytic leukemia are more likely to live an extra two years if they are treated by a disease-specific expert rather than a generalist. Patients with multiple myeloma have inferior outcomes if they are not evaluated by a myeloma specialist within a year of diagnosis. Furthermore, there exist significant barriers to adherence with evidenced-based guidelines among community-based oncologists.
Edward Gorak, DO, MBA, MS, FACP Head, Division of Cancer Medicine
Our relationship with our Houston colleagues enables us ongoing opportunities to bring the latest developments to our blood cancer patients, thus allowing our clinical trials portfolio to grow. At Baptist MD Anderson, we are passionate about taking care of patients with lymphoma, leukemias, multiple myeloma and other blood malignancies and disorders. Our model represents a unique multidisciplinary and comprehensive approach to the care of the blood cancer patient. Our outpatient team encompasses providers who are hematologic malignancy-specific and includes physicians, nurse practitioners, pharmacists, nurse navigators, clinic nurses and medical assistants. Our inpatient team is comprised of a dedicated Baptist MD Anderson blood cancer physician consultant and an oncology-specific hospitalist. All of our patients are discussed at our multidisciplinary care conference, and a team-based approach to care is instilled in our culture. The partnership with MD Anderson in Houston affords us continued collaboration with the worldâ€™s experts in blood cancers. Our relationship with our Houston colleagues enables us ongoing opportunities to bring the latest
developments to our blood cancer patients and our clinical trials portfolio continues to grow. In addition, our hematology physicians are on the cutting edge of blood cancer research development as active members of several National Cancer Institute steering committees and advisors for biotechnology advances.
Enhanced Recovery After Surgery protocols create powerful new combination for lung cancer treatment A long-acting nerve block combined with Enhanced Recovery After Surgery (ERAS) protocols and minimally invasive procedures can help reduce a patient’s post-operative hospital stay. With video-assisted thoracoscopic surgery (VATS), patients with lung cancer no longer require cracked ribs and lengthy incisions to receive quality surgical results. As tools for sealing blood vessels and air passageways improve, minimally invasive surgery produces the same predicted outcomes as other modalities. “The technique itself has really transformed our ability to provide lung cancer surgery care to far more patients, including those who previously would not have been considered for an operation in the past,” said Bill Putnam, MD, medical director for Baptist MD Anderson, and an internationally-recognized thoracic surgeon. “Minimally invasive procedures tend to minimize surgical trauma, as well as reduce the costs associated with operating room equipment. They decrease the costs of care, increase the patient’s comfort and enhance recovery.”
To further shorten a patient’s hospital stay and also help prevent potential narcotic abuse, Baptist MD Anderson thoracic surgeons now place multiple local rib blocks using a liposomal bupivacaine injectable suspension in addition to general anesthesia. Dr. Putnam said the pain he’s seen in his patients has been minimal – in some cases, eliminating any narcotic pain medication by using over-the-counter medications like acetaminophen or ibuprofen. “These outcomes are very welcomed by our patients and their families,” Dr. Putnam said. “Comfort is important to everyone; but if we can manage pain without narcotic use, we will do our part to decrease the opioid epidemic in our region.” Studies show patients who undergo minimally invasive procedures often have shortened hospital stays, recover faster, and require less pain medication. (Continued on page 32)
Adopting ERAS protocols for surgical programs Baptist MD Anderson launched MD Anderson’s ERAS protocols for our colorectal and thoracic surgery programs in 2017, and for our gynecology and urology programs in 2018. Important steps for each protocol take place before, during and after a procedure and can include components such as: • Pre-operative counseling • Nutrition planning and preparation • Minimally invasive surgery when appropriate • Opioid-sparing medicine regimens • Early mobilization after surgery “Shorter hospital stays are wonderful for the patient and physician, but they are equally embraced by our payors – whether that’s the government or private insurers,” Dr. Putnam said. “When minimally invasive procedures are combined with long-acting regional nerve-block anesthesia and faster recovery, we have a very powerful combination.”
• Post-discharge follow-up Studies have shown that ERAS protocols provide many benefits including, notably, shorter length of hospital stay and reduced treatment complications, thereby helping patients to have the best possible outcomes after surgery. Baptist MD Anderson looks forward to adopting ERAS protocols for our additional surgical programs in the coming year.
Donors We are grateful to the many individuals and organizations that support our mission* to treat not just the disease but the person. Thank you for your extraordinary commitment and generosity, which enable Baptist MD Anderson to provide leading-edge, compassionate care to individuals in Northeast Florida and the region. For more information on how you can help us in Making Cancer HistoryÂŽ, please visit endcancerjax.com. $5,000,000+ Blanche and Luther Coggin Golf Classic Committee Wine Auction Committee
$1,000,000+ Joan and Preston Haskell Margaret and Robert Hill, Jr. Jacksonville Jaguars Foundation Debbie and Sutton McGehee Joannie Newton Peyton Family SEI Edna Sproull Williams Foundation Sherry and David Thorpe Norma and Jack Williams James H. Winston
$500,000+ Haskell Company Mori, Bean & Brooks NSABP Foundation
$250,000+ Alex and Scot Ackerman
Marilyn and Pete Carpenter William H. Gardner Eileen and Michael Grebe Paul Harden Miller Electric Company RITA Foundation Ruby and Carlton Spence Waves of Gray 5K
$100,000+ Leigh Ann and Franklin Danley Mittal and Ankit Desai Marian Feder and David Ashman Cheryl Grabenstein Susan and Hugh Greene Gresham, Smith and Partners Joan and Ronald Levin PNC Bank Jackie and Bill Putnam Riding Into History Jennie and Mike Shad Kimberly and Richard Sisisky Deanie and Jay Stein Louise D. Wicker Scott Wooten
Atlantic Beach Vintage
Auld & White Constructors
Ryan Ali and Benjamin Crumley
Barco Family Foundation
Rosalind and Hudson Berrey
Claudia and Charles Baggs
Brasfield & Gorrie
Catharine and Jay Bowling
Cara and Scott Baity
Catharine and Jay Bowling
Susan and Hugh Greene
Lisa and Greg Delaney
Gresham, Smith & Partners
Gwen Gallagher-Howard and
Gwen Gallagher-Howard and
Columbia County Resources
Joan and Preston Haskell
Gaylynn and Donald B. Driver, Jr.
Irving W. Feuer
Margaret and Robert Hill, Jr.
William H. Gardner
Catherine and David Graham
Arthur L. Graham
George William Groh
Melanie and Gary Husk
Kimberly and Richard Sisisky
Thomas M. Kirbo and Irene Kirbo
Susan G. Komen
Cathy and Keith Tickell
Claudia and Earl Mally
Edward F. Magee
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Heather and Michael Olson
Kate and Lori Ann Mehl
Sharon and Christopher Pezzi
Anina and Ralph Walter
Dianne and David Rice
Cathy and Keith Tickell
Carolyn and Judson Whorton
* Current as of January 1, 2019
Patricia and Thom Borowy
Janet and John F. Wilbanks
Buddy Check 12
Nicole and Matthew Zuino
The arts enrich our healing environment At Baptist MD Anderson, we believe that art is integral to the healing process, and contributes to an uplifting environment for patients, caregivers and team members. Our new facility provides a welcoming environment to showcase a carefully selected collection of art that complements the extraordinary care and full spectrum of support services available at Baptist MD Anderson. We are extremely grateful to the donors whose generosity allows us to build this collection and maintain it over time. To learn more about our Healing Arts Program, and view documentary videos featuring five featured artists, visit endcancerjax.com.
1301 Palm Avenue Jacksonville, FL 32207 1.844.632.2278 BaptistMDAnderson.com BaptistMDAnderson.com
2018 Annual Report