2012 - 2013 Oncology Annual Report

The Future Is Bright

2012—2013

ncology Annual Report Spagnoli Family Cancer Center

A member of the Greater Hudson Valley Health System

Welcome Welcome It is with great pride that I present the 2012—2013 annual report for Orange Regional Medical Center’s Spagnoli Family Cancer Center.

We have continued to keep pace with the rapid evolution of exciting technologies in our field and our oncology program remains equally committed to one of the most important components of cancer treatment: patient care. We take a collaborative approach to each unique case to ensure that all patients receive the expert attention, multidisciplinary perspectives and quality treatment they deserve.

We believe in leveraging a multifaceted care system to offer an unprecedented level of support, guidance and, of course, treatment to every patient at every stage, from diagnosis to remission. This means continually investing our steadfast energy and resources into ground-breaking research, new developments in technology, complementary therapeutic services and more. In keeping with this mission, we enacted or improved the following services and technology in 2012 and 2013: • Our expanded patient navigator program guides our patients through their diagnosis and treatment program comfortably and effectively, partnering with community services to ensure unimpeded care to every individual.

• Our nationally certified oncology nursing team brings compassion and expertise to each patient’s unique experience.

• Our large infusion center offers a relaxing, restorative atmosphere alongside the expert guidance of a certified oncology nursing team.

• Endobronchial Ultrasound (EBUS) identifies the presence and stage of cancer in the lung through an incredibly accurate process with minimal invasion.

• Endoscopic Ultrasound (EUS) uses ultrasound and endoscopy to inspect the digestive tract and nearby organs and tissues for potential cancer and its stages.

• Our Positron Emission Tomography/Computed Tomography (PET/CT) technology continues to obtain accurate examinations and crucial assessments of a patient’s condition through state-of-the-art imaging technology, offering invaluable information to aid in the diagnosis of cancer and various neurological diseases. It also assists with the planning and management of unique treatments.

• Radiofrequency Ablation uses an extremely effective endoscopic procedure to treat the pre-cancerous condition known as Barrett’s esophagus, an affliction that commonly disrupts the esophageal lining as a result of gastroesophageal reflux (GERD).

• Yttrium-90 (Y-90) Radio Ablation injects radioactive isotopes with microscopic precision to effectively treat liver cancer by targeting tumors.

We prioritize the ease of access for our patients, maintaining a simple, thorough and friendly patient care navigation program that offers the welcome and guidance of our expert support staff every step of the way.

We believe in treating the whole patient, not just the symptoms of cancer. This means going above and beyond to offer rigorous, methodical and groundbreaking treatment, as well as compassionate guidance and psychological support.

However, this also means leveraging clinical trials and investing in the future of cancer research to afford viable, accessible treatment options to our patients.

Sincerely,

Jeffery Stewart, MD Medical Director of Cancer Care

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The Future Is Bright The Future Is Bright At Orange Regional Medical Center, everything we do reflects back to our mission, “to improve the health of our community by providing exceptional healthcare.” This mission is foundational and serves as the cornerstone of our oncology program, driving us in our fight to eliminate this disease.

We offer the highest quality of cancer care, which is evidenced by our accreditation through the Commission on Cancer (COC) of the American College of Surgeons (ACOS), which awarded us a gold commendation for excellence in cancer care. This commendation assures our patients that they will receive the best care from their diagnosis, throughout their treatment and to survivorship or end-of-life care.

I am pleased to share that our portfolio of diagnostic, treatment and survivorship programs and services continues to expand and now includes complex head and neck protocols, lymphedema protocols for at risk patients, genetic counseling services, increased participation in cutting edge clinical trials and growth of patient and family support groups.

Early diagnosis and treatment is critical to improving outcomes. We have expanded both the number of screenings and the types of cancer screenings offered. New programs include screenings for thyroid and lung. In March 2013, Orange Regional became the first hospital in the Hudson Valley to develop and implement a lung screening clinic for patients. To date, Medical Director of Lung Tumor Site, Dr. Lewis, has identified and staged several patients who were asymptomatic.

We are committed to supporting our community by offering cancer awareness and educational forums. Between 2012 and 2013, we provided and/or participated in over 36 community outreach events. Eight of these events were fundraisers that collectively donated over $85,000 in support of cancer research by the American Cancer Society (ACS).

We also offered over 100 patient and/or family support group sessions and expanded our complementary alternative medicine (CAM) programs to include: gentle yoga, Reiki, aromatherapy and most recently, access to acupuncture.

Ongoing staff education and competency is paramount to the success of our program and toward that end, we have: • Achieved Survivorship Training and Rehabilitation (STAR) certification (July 2013). Orange Regional is the first hospital in the Hudson Valley and the second in NYS to achieve this designation. We have over 25 members on our care team (nurses, providers, therapists and administration) who achieved individual certification.

• Established an active Oncology Nursing Society (ONS) chapter and proudly recognize that over 60 percent of our nursing team has achieved the highest level of professional certification.

• Began our Magnet journey, seeking designation by the American Nurses Credentialing Center. This designation, spearheaded by our chief nursing officer, recognizes organizations for quality patient care, nursing excellence and innovations in professional nursing practice.

• Offered tumor symposiums (breast and lung) led by our medical leadership team.

I can confidently say that Orange Regional’s oncology program has made continual inroads in improving our patient and family experience and the quality of care provided to our cancer patients. Our achievements have been made possible thanks to the vision of our oncology leadership team in identifying and providing broad treatment options, including the tireless efforts of our care team (physicians, nurses and ancillaries) and the support of our administration in funding advanced technology and implementation of new programs and services. As a result, we have been able to improve outcomes, which ultimately saves lives.

Sincerely,

Sandra Iberger, MBA VP Operations, Greater Hudson Valley Health System

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Support for the Whole Person: From Cancer Patient to Cancer Survivor Our goal at Orange Regional Medical Center is to not only provide excellent clinical care, but to provide support for the whole person—we are here to help in the journey from cancer patient to cancer survivor. The emotional and physical challenges faced by patients can be daunting and we know that there is a variety of support that patients and their families need to face those challenges.

Both the treatments for cancer and the disease itself can have systemic effects on the body, such as fatigue, lymphedema and neurological changes. The Survivorship Training and Rehabilitation (STAR) Program is specially designed to address these issues. We have seen the beneficial effects of this targeted therapy and are very proud to offer the STAR Program to our patients.

We have continued to expand our support groups and now offer a breast cancer support group, head and neck cancer support group and lung cancer support group. These groups are facilitated by our breast and lung, head and neck cancer patient navigators, along with a psychosocial professional and are open to both patients and their loved ones.

We also offer a cancer caregiver and allies support group for those caring for cancer patients. These groups offer emotional support, practical advice and an opportunity to meet with others facing the same challenges.

We believe that complementary therapies can be a valuable part of cancer care. We have offered Reiki and pet therapy programs for a number of years, but have recently added gentle yoga and access to acupuncture as services for our patients. We will be completing a pilot study of holistic nursing on our inpatient oncology unit, which will include such techniques as aromatherapy and guided imagery and we will be using the results of this study to guide future program offerings.

We are very fortunate in the oncology program at Orange Regional to have caring professionals who truly want to make a difference in the lives of our patients and understand that excellent care not only heals the body, but nourishes the soul.

Sincerely,

Regina Toomey Bueno, MS Administrator, Oncology Services, Greater Hudson Valley Health System

Cancer Committee 2014 Jeffrey Stewart, MD

Medical Director Cancer Care and Chairman

Jessica Gerlach, CCRP Manager of Clinical Research and Oncology Community Outreach

Thomas Eanelli, MD

Medical Director of Radiation Oncology

Betty Koshy, MHA

Joseph Racanelli, MD

Diagnostic Imaging–Breast Center Co-Chairman

Monica DelRosso, RN, OCN Oncology Nursing

Nader Okby, MD

Medical Director of Tumor Site Strategy

Michele Worden, RN, CBCN Breast Cancer Patient Navigator

Sergey Koyfman, DO

Surgery-Head and Neck Program Chairman

Gnanamba Kondagunta, MD Medical Oncology/CPL

Jayne O’Malley, RN, OCN

Cleveland Lewis, MD

Thoracic Surgery/QI Coordinator and Lung Program Chairman

Theresa Gorman-Cobb

Case Management

Nicole Karchner, Pharm D

Clinical Pharmacy Manager

Manual Perry, MD

Medical Oncology

Christine Green, AAS

Information Technology

Arvind Kamthan, MD

Medical Oncology

Jeannette Carbone-Marsh

Chief Activity Therapist

Emma Fattakhov, MD

Medical Director of Palliative Care

Regina Toomey Bueno, MS

Administrator of Oncology Services

Dan Grady, CEO

Hospice of Orange and Sullivan Counties

Sandra Iberger, MBA

VP Operations

Sandy Casillo, MS

Nutritional Services

Karen Loos, CTR

Cancer Registry Manager/ Cancer Registry Quality Coordinator

Kelly Roth, RN, OCN

Quality Support

Lidia Koulova, MD

Medical Oncology

Maria Nywening, CTR

Certified Tumor Registrar/ Cancer Conference Coordinator

Lesley Stead, MD

Medical Oncology

Lu Ann Witte, CTR

Certified Tumor Registrar

Gurvinder Sethi, MD

Medical Oncology

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Radiation Oncology Manager

Lung, Head and Neck Cancer Patient Navigator

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Oncology Nursing

Ann DiAgostino, RN Nursing Service Administrator

In December 2012, 61 percent of Orange Regional Medical Center’s oncology nursing staff was nationally certified. The Oncology Certified Nurse (OCN) is a clinical expert in the care of the cancer patient. What does this mean for our patients? It means that they can expect their OCN nurses to act as clinical experts, compassionate healers and unflagging advocates and educators.

Oncology nurses are tireless in their pursuit of improving the care of their patients, families and communities. The oncology nursing shared congress council worked hard all year to bring to their peers the newest information about medications for the patients, social support and an in-depth means to improve their quality of life.

The oncology nursing team added five BSN graduate students to the team. They were paired with experienced OCN/BSN nurses for 14 weeks. The new nurses and their preceptors met with the nurse director to review the 14-week orientation at the beginning and then weekly to discuss the education care and develop a communication strategy for issues/concerns for the team. The new process produced very engaged new nurses with a strong professional relationship with their preceptors and peers.

Orange Regional’s oncology nursing has become a resource for the community with oncology nurses offering an Oncology Nursing Society Chemotherapy/Biotherapy course, collaborating on our shared patients and assisting them in increasing methods for preventing cancer.

Cancer Registry A Cancer Registry is an information system designed for the collection, management and analysis of data on persons with the diagnosis of cancer. Orange Regional maintains a cancer registry to ensure that health officials have accurate and timely information while ensuring the availability of data for treatment, research and educational purposes.

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Patient Navigator Program A cancer diagnosis brings many challenges for patients and loved ones. To assist patients through their cancer journey, Orange Regional Medical Center provides a complementary patient navigation service: a patient-centered approach to care. With close contact and communication, the patient navigators assist in effective and efficient care coordination and work closely with the multidisciplinary team in identifying patient needs. Navigators partner with the community services within the community to overcome barriers and improve outcomes for our patients. Navigator programs were established to help address health care disparities and barriers to care for patients. The navigators’ role is to help identify and overcome obstacles and facilitate treatment and wellness with timely access to quality medical care.

Introducing Our Newest Patient Navigator

Eileen Schmidt, LCSW Palliative Care Patient Navigator

Palliative care is ” specialized medical care for people with serious illnesses.

It focuses on providing patients with relief from the symptoms, pain and stress of a serious illness — whatever the diagnosis.

— Eileen Schmidt

”

Eileen Schmidt joined Orange Regional as the Palliative Care Patient Navigator.

Eileen works with Dr. Emma Fattakhov in providing palliative care services to our patients and their families. She has an extensive background in Hospice and Social Work and spent the last 12 years as the Director of Counseling Services at United Hospice of Rockland where she coordinated and managed all aspects of counseling services including social work, spiritual care, volunteers and bereavement. Eileen holds a Master of Social Work degree from New York University and a Bachelor of Arts degree in Human Services from the College of New Rochelle. She has a particular interest and passion for bereavement counseling and holds certificates in Bereavement Counseling and Bereavement Supervision from the Archdiocese of New York. Eileen can be reached at 845-741-3607 or eschmidt@ormc.org.

Palliative Care Program The palliative care program at Orange Regional provides the highest level of comfort and support to patients 18 years of age and older who suffer from the pain, symptoms and the stress of a serious illness such as cancer. Palliative care is provided to inpatients early in the disease process. The program enlists a team of experts with the resources to help patients reach their personal goals, treating each patient on a case-by-case basis.

The program offers direction and aid to patients admitted to Orange Regional, including symptom management, nutritional guidance, case management, social support, psychological support, spiritual comfort and ethical support. Through the palliative care program, Orange Regional helps patients obtain the resources they need to best manage their illness as an inpatient or upon returning home.

Emma Fattakhov, M.D. has joined Orange Regional as Medical Director of the Palliative Care Program. Dr. Fattakhov has extensive experience in providing medical care to both hospice and palliative care patients. She completed an Internal Medicine Residency at Lutheran Medical Center in Brooklyn, NY. She also completed a Geriatric Fellowship at New York University Langone Medical Center as well as a Hospice and Palliative Medicine Fellowship at Cook County Health and Hospital Systems, Rush University Medical Center in Chicago, IL. Dr. Fattakhov can be reached at 845-741-9578 or efattakhov@ormc.org.

Emma Fattakhov, MD Medical Director of Palliative Care PAGE 6

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Orange Regional Medical Center recognizes that a cancer diagnosis can be life changing and difficult. In order to provide patients and their families with individualized assistance and support during their cancer journey, we have two experienced and professionally trained Oncology Nurse Navigators, Michele Worden, RN, CBCN (breast cancer) and Jayne O’Malley, RN, OCN (lung, head and neck cancer). Our goal through the Orange Regional complementary navigation program is to provide compassionate care and support to patients and their families. This year, our navigators received accolades from both the organization and from a patient’s family.

To Contact Our Breast and Lung, Head and Neck Navigators:

Michele Worden RN, CBCN Breast Cancer Patient Navigator

Jayne O’Malley RN, OCN Lung, Head and Neck Cancer Patient Navigator

Orange Regional Medical Center

Spagnoli Family Cancer Center

Telephone: (845) 741-2334

Telephone: (845) 421-0108

Email: mworden@ormc.org

Email: jomalley@ormc.org

To Our Very Own “Angel” Michele, Thank you for being always there for Tommy and me. You are a wonderful person. God bless you for being in our life. When I could not pull it together, you held me steady-Tom loved you and so do I. Love, Debbie, Gary, Donovan and Family

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In 2013, Jayne was selected as the Star of The Year for her diligence and hard work with lung, oral, head and neck cancer patients. She established a head and neck support group for patients in partnership with Support for People with Oral, Head and Neck Cancer (SPOHNC) and facilitator of our lung cancer support group.

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The

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In the Beginning Orange Regional’s process of developing a thyroid cancer “Program of Excellence” did not happen overnight. As a matter of fact, it was a journey that took many years and several twists and turns of luck, fate and enlightenment.

Historically, well-differentiated thyroid cancer (WDTC) has stood in the shadow of other malignancies possessing higher volumes, larger research endowments, lower survival rates, and more public exposure. Furthermore, WDTC’s relative obscurity was a direct function of an antiquated and inflexible treatment algorithm that was more anecdotally driven than evidence-based.

Thankfully, the development of improved diagnostic technology and techniques has stimulated earlier diagnoses, leading to stage migration and a huge boom in volume. It also availed head and neck surgeons with better preoperative information to guide not just their biopsy needles, but their scalpals.

Soon, “blind” thyroidectomies were replaced by thoughtful and prospectively planned resections, which in turn produced the momentum necessary to rediscover how best to treat WDTC.

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Head & Neck Program Sergey Koyfman, DO

Medical Director of Head and Neck Tumor Site

Thomas Eanelli, MD

Medical Director of Radiation Oncology

Emelito Gonzales, MD

Radiation Oncology

Joseph Racanelli, MD Radiology

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Nader Okby, MD

Medical Director of Tumor Site Strategy

Gnanamba Kondagunta, MD

Medical Oncology

Manual Perry, MD

Medical Oncology

Emma Fattakhov, MD

Medical Director of Palliative Care WWW.ORMC.ORG/CANCER

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Being told you have cancer is scary enough. The thought of having to travel for treatment is incovenient, stressful, expensive, and entirely overwhelming.

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Orange Regional is proud to have physician leaders in Head and Neck Surgery, Diagnostic Radiology, Radiation Oncology, and Pathology who have taken the time and energy to specialize in the management of WDTC. Through multidisciplinary Head and Neck Tumor Boards and an active relationship with, and regional referrals from the tertiary care centers in New York City and the Capital Region, we array of cutting-edge technology and treatment.

With New York City so close yet so far, Orange Regional has made a commitment to our community to build a “Thyroid Program of Excellence.” A place you can get not only the same level of treatment by a highly specialized and committed group of professionals, but more importantly, treatment delivered with compassion and empathy where your time is respected and your dignity preciously preserved in a place that you can literally call home.

Thomas Eanelli, MD Medical Director of Radiation Oncology

” Sergey Koyfman, DO Medical Director of Head and Neck Tumor Site

section

Leadership 2014 Jayne O’Malley, RN, OCN

Lung, Head and Neck Cancer Patient Navigator

Regina Toomey Bueno, MS

Administrator of Oncology Services

Sandra Iberger, MBA

VP Operations

Karen Loos, CTR

Cancer Registry Manager

Jessica Gerlach, CCRP Manager of Clinical Research and Oncology Community Outreach Betty Koshy, MHA

Radiation Oncology Manager

Diane Strysko, OTR

Director of Outpatient Rehabilitation

Gene Bernieri, MBA

Administrator of Diagnostic Imaging

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Neurological Cancer Program A diagnosis of neurological cancer can be particularly devastating to patients and their families. Having access to high quality, high tech care is critical in treating these cancers.

Fortunately, Orange Regional Medical Center can provide patients with cutting-edge technology along with a focus on the needs of the individual patient through all aspects of treatment.

G. Alexander Jones, MD

Medical Director of Neurological Tumor Site

The physicians and healthcare professionals at Orange Regional provide integrated care in our neurological cancer program. Dr. G. Alexander Jones, Medical Director of the Neurological Cancer Program describes it this way: “Our patients can feel confident that we have the expertise to deal with a wide variety of primary and metastatic neurological tumors. We have a highly skilled team of physicians, including medical and radiation oncologists, pathologists and radiologists who review our cases in our neurological cancer conferences, and we have the equipment and capability to provide innovative evidence-based care.�

At Orange Regional, we have the tools we need to diagnose and treat our patients. Accurate diagnosis helps us plan our treatment approach, and we have the latest MRI, 64-slice CT and PET/CT scans for imaging and the ability to do advanced pathologic studies of tumor genetics and molecular markers.

Our neurosurgeons perform complex brain surgery using frameless stereotactic microsurgery, which allows for an extremely precise removal of tumors while preserving healthy tissue. Tumors of the spine can be treated with a variety of techniques, including the minimally invasive STAR ablation procedure. We also have the ability to perform a surgery called kyphoplasty to reinforce a spine that has degenerated due to cancer, reducing pain and improving mobility.

Our radiation oncologists work with the neurosurgeons to perform stereotactic radio surgery in which a highly targeted beam or radiation is directed to the tumor without open surgery. Patients may also receive other types of radiation treatment to the brain or spine.

If the need for chemotherapy is identified by the medical oncologist, our infusion center can provide the needed care in a warm and welcoming environment. This comprehensive approach to neurological cancer care at Orange Regional Medical Center affords our patients state-of-the-art medical care close to home.

Neurology Program Leadership 2014 Alexander Jones, MD

Committee Chairman

Regina Toomey Bueno, MS

Administrator of Oncology Services

Thomas Eanelli, MD

Medical Director of Radiation Oncology

Sandra Iberger, MBA

VP Operations

Emelito Gonzales, MD

Radiation Oncology

Karen Loos, CTR

Cancer Registry Manager

Joseph Racanelli, MD Radiology Nader Okby, MD

Medical Director of Tumor Site Strategy

Gnanamba Kondagunta, MD

Medical Oncology

Manual Perry, MD

Medical Oncology

Emma Fattakhov, MD

Medical Director of Palliative Care

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Jessica Gerlach, CCRP Manager of Clinical Research and Oncology Community Outreach Betty Koshy, MHA

Radiation Oncology Manager

Diane Strysko, OTR

Director of Outpatient Rehabilitation

Gene Bernieri, MBA

Administrator of Diagnostic Imaging

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Tara Quinones’ diagnosis came as a surprise …

“One night in my sleep, my two daughters saw me having a seizure. They called 911 and the next thing I knew, I woke up in the ER being told I had a brain tumor,” she recalls.

Tara underwent brain surgery two weeks later and immediately began radiation and chemotherapy treatments for the next two months.

“I went to Orange Regional every day during that time. Throughout my treatments, I was welcomed with warm smiles and was provided with coffee or tea while I waited. The wait was never long and everything was explained to me thoroughly, including information about my treatments and what to expect.

When I had lost most of my hair, I decided to shave the rest off. When the Orange Regional staff saw me, they told me how beautiful I (still) was and that made me feel more empowered to push forward.”

Surprisingly, the treatments for Tara were quick and before long, it was the holiday season. “One day after my treatment, I was brought into one of the rooms where the staff had presented me with gift cards of more than $500. I was so beside myself I couldn’t stop shaking. It was such a humbling and overwhelming feeling of appreciation since I had no income and two girls that I had no clue how I would get a Christmas gift for.”

During her last week of treatment, Tara showed her gratitude to the Orange Regional staff by cooking Spanish rice.

“It was my way of showing my appreciation for all their warmth and support,” she said. “Today I live in Florida, still struggling financially but feeling stronger everyday and hopeful that one day my MRI will come back with no sign of a tumor. Thanks to all the doctors & staff at Orange Regional Radiology & Hospital.

I wish I had taken a picture with them.”

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Technology / Advancements Screening For Lung Cancer

Cleveland Lewis, MD Medical Director of Lung Tumor Site & Oncology Quality

In the United States, lung cancer is the leading cause of cancer deaths every year. It is the second most common cancer in both men and women, accounting for approximately 14 percent of all cancers diagnosed. It has been estimated that over 160,000 people will die of lung cancer this year alone, and this number surpasses the deaths from breast, prostate and colon cancer combined. The 5-year life expectancy of lung cancer approaches 14 percent. However, we know that persons with early stage lung cancers successfully treated with surgery have up to a 70 percent chance of cure. Unfortunately, later stage lung cancers typically have a survival rate well below 10 percent, and until now, it has been very difficult to consistently find early-stage lung cancers in patients because the majority of these small tumors elicit few or no symptoms. Typically, once lung cancer becomes symptomatic, it has already advanced to the later stages.

Until now, we have not had a reliable, evidence-based method of screening individuals for lung cancer. Previous attempts at screening included using collected sputum samples and routine chest radiographs. None of these modalities demonstrated any improvement in overall survival. However, in 2011, the results of the National Lung Cancer Screening Trial were published in the New England Journal of Medicine stating that the use of low-dose helical CT scans versus routine chest x-rays was associated with a 20 percent increase in the CT scan group of patients. This finding was seen only in a small subset of high-risk patients. Once this data was presented, the National Comprehensive Cancer Network (NCCN) released its recommendation for lung cancer screening and made it a 1A recommendation—the highest level possible.

We examined the overwhelming evidence stated above and used the NCCN criteria to create a lung cancer screening program at Orange Regional Medical Center. For our program, any patient aged 55 to 74 years of age is eligible if he or she has at least a 30 pack years’ history of smoking, or the equivalent of smoking one pack of cigarettes a day for at least 30 years. For a current non-smoker, to be eligible, he or she would have had to stop smoking less than 15 years ago. Once the patient calls for an appointment, he or she is carefully screened by the call service team for eligibility.

If the patient is eligible, he or she is given an appointment and the patient’s information is given to the lung cancer navigator who verifies the eligibility and the appointment.

At the time of the appointment, the patient arrives at 30 Hatfield Lane and a dedicated low-dose helical CT scan of the chest is performed. The study is interpreted immediately by a radiologist, and the patient has a consultation with either the thoracic surgeon or the lung cancer navigator, which includes smoking cessation information if warranted. If the screening exam is negative for any abnormal findings, an annual follow-up study is recommended as long as the patient is eligible according to the above criteria. If an abnormality is found, the patient is then referred to the office of the thoracic surgeon where the appropriate follow-up scans and/or diagnostic studies are undertaken.

At this time, the screening exam is not reimbursed, but that is likely to change in the very near future. Currently, patients are charged $300 for a screening study, which just covers our costs. However, the U.S. Selective Preventive Task Force has recommended that lung cancer screening become a recognized method of cancer screening. Before making a final recommendation, this task force solicited public opinion, and this window closed August 26, 2013. Under the Affordable Care Act, any final recommendation from this group has to be reimbursed by the Centers for Medicare and Medicaid (CMS). If the recommendation comes to fruition, Orange Regional will be at the forefront of providing this very vital service to the people of the Hudson Valley.

Lung Program Leadership 2014

Cleveland Lewis, MD

Committee Chairman

Thomas Eanelli, MD Medical Director of Radiation Oncology Emelito Gonzales, MD

Jayne O’Malley, RN, OCN Lung, Head and Neck Cancer Patient Navigator Regina Toomey Bueno, MS Administrator of Oncology Services Sandra Iberger, MBA

VP Operations

Joseph Racanelli, MD Radiology

Karen Loos, CTR

Cancer Registry Manager

Nader Okby, MD Medical Director of Tumor Site Strategy

Jessica Gerlach, CCRP Manager of Clinical Research and Oncology Community Outreach

Gnanamba Kondagunta, MD

Medical Oncology

Betty Koshy, MHA Radiation Oncology Manager

Manual Perry, MD

Medical Oncology

Diane Strysko, OTR Director of Outpatient Rehabilitation

Radiation Oncology

Emma Fattakhov, MD Medical Director of Palliative Care PAGE 12

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Diagnostic Imaging Support of Oncology and Radiation Oncology Orange Regional Medical Center Oncology and Radiation Therapy Service line works seamlessly and synergistically with Diagnostic Imaging. Diagnostic imaging provides support at three locations. Locations include the Orange Regional Medical Center main hospital campus, the Outpatient Pavilion and the Goshen Patient Service Center (GPSC).

Gene Bernieri, MBA Administrator of Diagnostic Imaging Greater Hudson Valley Health System

At the main campus, services include a full array of direct radiology and digital x-ray/fluoroscopic imaging, nuclear medicine (SPECT CT) and I-131 thyroid inpatient treatment, three CT scanners (2—64 slice), high-field open MRI, high-end diagnostic ultrasound and a comprehensive surgery and procedure center. The interventional radiology center includes single plane and bi-plane imaging systems, digital breast imaging, high-end ultrasound and a wide bore 16 slice CT. Many advanced procedures for the treatment of tumors are performed in the interventional radiology center, including Y-90 microspheres and tumor ablations.

The Pavilion and GPSC imaging support includes CT, CT for radiation treatment planning, high-field MRI, Ultrasound, CR Radiographic and Fluoroscopic Imaging, Nuclear Medicine and PET/CT. Nuclear Medicine with I-131 thyroid treatment.

All equipment is American College of Radiology certified, assuring the gold standard in quality.

Board-certified and Fellowship trained radiologists use high-end image distribution and speech technology to generate the highest quality reports and procedures in industry best times. Technical staff are New York State licensed and American Registry of Radiologic Technologist certified. Specially trained and certified diagnostic imaging registered nurses assure patient safety and support for diagnostic and therapeutic procedures.

Regular radiation safety committee and tumor board meetings create a highly interactive collaborative relationship between oncology, radiation oncology and diagnostic imaging, assuring the highest patient quality outcomes.

Molecular Targeted Therapy As more and more medical research has clarified the genetic mechanisms of unregulated cell growth, the ability to take advantage of this vital information has become a reality.

It is now established that cancers grow due to mutations in genes that regulate cellular production. Under normal conditions, these genes and the enzyme proteins they predetermine are controlled by a complex mechanism involving other proteins and cellular signals. However, when a mutation occurs in the gene, the predetermined protein no longer responds to the normal “checks and balances” and can drive a cell to reproduce uncontrollably, ultimately leading to a cancerous tumor. Of interest is that certain mutations Nader Okby, MD, are important in the development of some cancers, but the same mutation may have a Medical Director of minimal effect in another type of cancer. For example, mutation X may be important in the Tumor Site Strategy development of lung cancer but have virtually no effect in colon cancers. Many cancers harbor mutations in the same genes, but what matters most are the “driver mutations” that promote continued reproduction in a particular type of cancer. These “driver mutations” can be targeted with newer medications designed specifically to take advantage of the known genetic defect.

A critical component of the cancer program at Orange Regional is the ability to analyze cancerous tumors for gene mutations and to use targeted therapy to treat patients with the pertinent mutation. Some of the genes that are analyzed using sophisticated molecular techniques include EGFR, Alk, Met, Kras, Ros1, Braf, Her-2/neu and jak2, to name a few.

The set of genes that are analyzed is dependent on tumor type and location. Such advances in the understanding of genetic mechanisms in cancer have led to impressive results in patients at Orange Regional.

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aner Patient

Advanced Cancer Care Ray W. Moody, M.D. Breast Center Many women lack medical coverage and face serious barriers to breast care. Early detection is one of the most vital issues in fighting breast cancer and when detected early, this disease becomes eminently treatable in many cases. Often, women with no insurance do not have appropriate breast care services, which increases the risk of delayed diagnosis. Women without insurance are more likely to receive a late-stage breast cancer diagnosis and are 30 to 50 percent more likely to die from the disease than women with insurance.

The Ray W. Moody, M.D. Breast Center has seen a growing demand for services of uninsured women in need of breast examinations, mammograms and diagnostic treatment. Orange Regional has been able to do this with the help of the Cancer Services Program of Orange County, which provides funding for breast cancer screenings to uninsured women over the age of 40. There is a vital need to increase awareness about breast services that are available to women who have no insurance. The Ray W. Moody, M.D. Breast Center is proud to provide this much needed service in conjunction with the Cancer Services Program of Orange County.

In 2012, the partnership between the Ray W. Moody, M.D. Breast Center and the Cancer Services Program of Orange County held four screenings in which 591 women were screened through this program. In 2013, an additional 537 free mammographies were performed for women in need.

The partnership between the Ray W. Moody, M.D. Breast Center and the Cancer Services Program of Orange County ensures that hundreds of women will receive mammograms and follow-up care. For information and eligibility requirements to receive a FREE mammogram, contact the Ray W. Moody, M.D. Breast Center at 845-695-5827 or the Cancer Services Program of Orange County at 845-561-8050.

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Support Group Orange Regional hosts a regular support group where breast cancer patients, their families and friends can ask questions and obtain support from fellow group members.

It is held at Orange Regional Community Health Education Center, 110 Crystal Run Rd., Middletown, New York.

For more information, contact the Orange Regional Health Connection at 1-888-321-6762.

Breast Program Leadership 2014 Howard Karpoff, MD

Committee Co-Chairman

Joseph Racanelli, MD Medical Director of the Ray W. Moody, M.D. Breast Center and Co-Chairman Thomas Eanelli, MD Medical Director of Radiation Oncology Emelito Gonzales, MD

Radiation Oncology

Nader Okby, MD

VP Medical Staff/Pathology

Gnanamba Kondagunta, MD

Medical Oncology

Manual Perry, MD

Medical Oncology

Emma Fattakhov, MD

Medical Director of Palliative Care

Regina Toomey Bueno, MS Administrator of Oncology Services Sandra Iberger, MBA

VP Operations

Karen Loos, CTR

Cancer Registry Manager

Lu Ann Witte, CTR

Certified Tumor Registrar

Jessica Gerlach, CCRP Manager of Clinical Research and Oncology Community Outreach Betty Koshy, MHA

Radiation Oncology Manager

Michele Worden, RN, CBCN

Breast Cancer Patient Navigator

Diane Strysko, OTR

Director of Outpatient Rehabilitation

Nicole Karchner, Pharm D

Clinical Pharmacy Manager

Jay Belcher

Data Imaging Specialist

Jeannette Carbone-Marsh

Chief Activity Therapist

Eileen Schmidt, LCSW

Palliative Care

Kelly Roth, RN

Quality Support

WWW.ORMC.ORG/CANCER

Headline Survivorship Training and Rehabilitation Program At Orange Regional Medical Center, we are committed to offering the best available survivorship services. This is why we have implemented the Survivorship Training and STAR Program Team Rehabilitation Program® (STAR) Program.

Our staff have been trained and certified in oncology rehabilitation care to help cancer survivors regain the best quality of life possible. Our team implements research-based protocols that have been proven to help cancer survivors optimally heal and function.

In 2013, Orange Regional earned its STAR certification from Oncology Rehab Partners. STAR Program certification allows us to offer premium oncology rehabilitation services to cancer survivors who suffer from debilitating side effects caused by treatment. To earn this designation, Orange Regional successfully completed Oncology Rehab Partners STAR Program Certification, a conventional medicine and evidence-based standardized model of oncology rehabilitation service delivery, successfully implementing the program’s evaluation and treatment protocols and rehabilitation training. For more information on the STAR Program, contact Director of Outpatient Rehabilitation, Diane Strysko, at 845-695-8731 or dstrysko@ormc.org or visit www.ormc.org/CancerRehabilitation.

Clinical Oncology Trials Orange Regional Medical Center has an active Clinical Oncology Trials program in place working with all of the local Oncologists and Radiation Oncologists. Orange Regional Medical Center is a member of the Southwest Oncology Group (SWOG) and participates in many SWOG Studies. We also participate in American College of Surgeons Oncology Group (ACOSOG), Radiation Therapy Oncology Group (RTOG) and other Inter-group studies through the Cancer Trials Support Unit (CTSU) supported by the National Cancer Institute.

Clinical trials provide patients at all stages of cancer with leading edge medical treatment and the highest level of care. In most cases, the new treatment has already shown promise of being an improvement over the standard treatment. Many clinical trials are tests to see how much better a new treatment works than the current one. Each clinical trial is approved

by Orange Regional’s institutional review board (IRB), a group of people who review the research to protect the rights of the patients. Our IRB assures that human subject research conducted at that site is in compliance with federal regulations pertaining to the protection of human subjects.

In 2013, the IRB met six times approving 12 new oncology protocols and renewing over 40. Currently there are 41 protocols to offer our oncology patients. Our department strives to pre-screen 100 percent of our analytic cases. In 2013, over 400 oncology patients were screened for clinical trials. The department was awarded a commendation for clinical trial accrual at the most recent American College of Surgeons survey and just passed a tri-annual audit. Clinical trials at Orange Regional are coordinated by a certified clinical research professional, with the oncology medical director as the principal investigator and seven local oncologists as investigators enrolling patients. For further information, contact Manager of Clinical Research and Oncology Community Outreach, Jessica Gerlach, at 845-333-1133 or jgerlach@ormc.org.

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Complementary Therapy Aromatherapy Aromatherapy is the newest of the holistic treatments added to the complementary therapy program at Orange Regional.

Aromatherapy uses medicinal grade therapeutic essential oils that can be applied alone, in its purest form, or mixed with a carrier oil. Essential oils are highly fragrant natural extracts taken from flowers, bark, stems, leaves, roots or other parts of a plant. A number of oils can be blended together and tailored to a patient’s individualized needs. The oils are absorbed by the body through the skin or through inhalation, promoting a healing energy. Aromatherapy is a complementary healing therapy that, when combined with traditional therapy as prescribed by a physician, promotes relaxation and comfort. For more information about aromatherapy at Orange Regional, please visit ormc.org/ComplementaryTherapy.

Orange Regional Medical Center’s Aromatherapy program is made possible by the Holistic Health Consultants of the Hudson Valley with generous support from the Corinne Feller Memorial Fund for Ovarian Cancer Research and Awareness.

Acupuncture Acupuncture is accessible on an outpatient basis through private practitioners as complementary therapy. It is the technique of inserting thin needles through the skin at specific acupoints or places on the body that control pain and other symptoms. Recent studies have demonstrated that, in some patients, acupuncture may: • Provide relief from nausea and vomiting following surgery or chemotherapy • Help reduce cancer-related pain • Complement traditional treatments for addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome and asthma

The Benefits of Healing Yoga Healing yoga classes for cancer and chronic disease patients and their caregivers utilize the practices of yoga therapy as a complement to traditional medicine in an effort to improve a patient’s quality of life.

The Physical Benefits

Psychological Benefits

• Increases resistance to illness and disease • Eases side effects • Induces the “relaxation response” • Supports a healthy immune system • Increases strength and flexibility and eases chronic pain

• Promotes stress reduction • Encourages healthy decision-making • Improves body image

Emotional Benefits • Eases depression and anxiety • Addresses anger and fear • Enables interactions with others who are facing cancer

Other Therapies In addition to aromatherapy and yoga, Orange Regional offers Reiki and pet therapy, as well as other integrative and complementary components, including light massage, music, salt lamps and guided imagery.

All, or a combination of these therapies, help to reduce anxiety, fear, stress and promote wellness.

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Community Outreach and Fundraising Orange Regional Medical Center strives to incorporate fundraising and community education toward healthy living, preventative health measures and health awareness. Throughout the year, we coordinate or participate in a broad range of community outreach programs. These programs include health fairs, trade expositions, facility tours, speakers’ bureau and educational seminars, as well as lectures, school career days, community health screenings and numerous charity walks. Through these activities, community members interact directly with representatives from the hospital.

Orange Regional Medical Center was a flagship sponsor of the American Cancer Society Making Strides Against Breast Cancer Walk. Over 350 employees participated and raised over $40,000.

Orange Regional participates in many events for various organizations, including the American Cancer Society. Healthcare presentations have also been made to community organizations by our oncology representatives. Community members may register for all screenings and health education seminars by calling Orange Regional Medical Center’s Health Connection hotline at 1-888-321-ORMC (6762). The hotline is a 24-hour, toll-free service available year round. Information is available in English or Spanish about physicians, hospital services and support groups. Participants may also register via the hospital web site at www.ormc.org.

Orange Regional’s 2012 fundraising efforts resulted in $74,890 for cancer and services. Generous support from the community also included $281,905 from the 22nd Annual Golf Classic. These funds were used for breast cancer screenings, education, patient support items, Cancer Survivor Day and Reiki therapy.

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Support Services Throughout the year, Orange Regional offers free cancer screenings and assessments to the community including, screenings for prostate, skin and breast cancers, as well as seminars and support groups.

Screenings In 2012, Orange Regional held several free community healthcare screenings including breast cancer, prostate cancer, skin cancer and oral, head and neck cancer. Cancer screenings, are based on the needs of the community and are consistent with evidence-based national guidelines. They are also held to detect cancers at an early stage, which improves the likelihood of increased survival. Our goals are to hold at least two screenings per year and to fill 95 percent of available appointments. The breast cancer screening program conducted 148 screenings. These free screenings are available year-round to those who are underserved or underinsured at the Ray W. Moody, M.D. Breast Center. They are also advertised within the community four times a year.

The prostate cancer screening program exceeded its goal with a total of 78 screenings. This free screening is held annually and is advertised within the community.

A total of 89 people were screened through the skin cancer screening program. This free screening is held annually and is advertised within the community.

The oral, head and neck cancer screening program exceeded its goal with a total of 84 screenings. These free screenings are held annually and are advertised within the community.

In 2013, Orange Regional added the following new screening programs: Orange Regional offers a thyroid cancer screening to help detect thyroid cancer for people 18 years of age or older.

The screening consists of an ultrasound, blood test and exam by one of the participating physicians.

Orange Regional began offering lung cancer screenings in February 2013.

The lung screening program (self-pay) evaluates participants for early signs of lung cancer. Under the direction of Cleveland Lewis, MD, Board-certified Thoracic Surgeon and Medical Director of Lung Tumor Site & Oncology Quality, the screening is done with a low-dose CT scan, a non-invasive procedure that is effective in detecting the earliest stages of lung cancer.

To be eligible for the screening, participants must be between the ages of 55 to 74, have had a minimum of 30 pack years’ of smoking, be a current smoker, or have quit within the past 15 years. Twenty-one screenings have been performed.

Medical Director of Head and Neck Tumor Site, Dr. Sergey Koyfman, performs a head and neck cancer screening on patient, Wendy Baker.

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Infusion Therapy

Look Good … Feel Better

The Spagnoli Family Cancer Center offers you and your loved ones the latest cancer fighting options, procedures and technology in a comfortable and caring environment.

Our Outpatient Infusion Therapy Center has a staff of nationally certified oncology registered nurses, all of whom have years of experience. Our nurses take special care to talk to and educate our patients about what they will experience during their treatment.

This free annual program teaches people in active cancer treatment ways to help themselves with appearance-related side effects. This program is offered jointly by the American Cancer Society, the Personal Care Products Council Foundation and the National Cosmetology Association.

Our infusion services include: Chemotherapy, IV Antibiotics, Aranesp Injection, Neupogen Injection, Neulasta Injections, Solumedrol Infusion, Tysabri Infusion, Peripherally Inserted Central Catheter (PICC) Line Dressing Change, Port Flush, Reclast Infusion, Adrenocorticotropic Hormone (ACTH) Simulation Test, Rabies Injection, Intravenous immunoglobulin (IVIG) Infusion, Phlebotomy, Platelet & Blood Transfusion and Vitamin Deficiency Injections.

Amenities offered: • Individual recliner and television • Blankets and blanket warmers • Pillows • Pet therapy • Soft drinks, juice and coffee • Free and convenient parking For more information, please visit www.ormc.org/cancer.

Road to Recovery Road to recovery provides volunteer based transportation assistance to cancer patients who otherwise do not have transportation to and from their cancer-related treatment appointments. Volunteer drivers complete an application and go through an interview and screening process. The American Cancer Society (ACS) then conducts a Department of Motor Vehicle check, as well as a check on the candidate’s auto insurance, as volunteer drivers utilize their own vehicle. Once volunteer drivers have been cleared, they attend an ACS volunteer training program. Access to volunteer transportation is dependent upon volunteer availability. The ACS does have a travel-reimbursement stipend program for eligible patients. It is intended to help offset the cost of a cab ride.

WWW.ORMC.ORG/CANCER

Patients who are interested in learning more about the program or in finding out if they are eligible for this service are encouraged to check with their Orange Regional outpatient nurse or to contact the ACS at 1-800-227-2345.

Contact report Tumor Site-Specific Cases treated at Orange Regional Medical Center

Summary by Body System

Primary Site ORAL CAVITY & PHARYNX

18

DIGESTIVE SYSTEM

157

RESPIRATORY SYSTEM

205

BONES & JOINTS

2

SOFT TISSUE

11

SKIN EXCLUDING BASAL & SQUAMOUS

12

BREAST

244

FEMALE GENITAL SYSTEM

36

MALE GENITAL SYSTEM

88

URINARY SYSTEM

119

BRAIN & OTHER NERVOUS SYSTEM

19

ENDOCRINE SYSTEM

71

LYMPHOMA 38 MYELOMA

2

LEUKEMIA 1 MESOTHELIOMA 1 MISCELLANEOUS 35

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Welcome

Find a Physician Visit ormc.org/physicians For a complete list of all our community outreach services and support groups, visit www.ormc.org/communityoutreach.

707 East Main Street Middletown, NY 10940 845-333-1000 www.ormc.org A member of the Greater Hudson Valley Health System