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The Cape Cod Healthcare Regional Cancer Network (CCHCRCN) brings together a team of specialists working collaboratively to deliver this exciting new array of treatment options to our patients.
is report goes into more detail about our accomplishments over the last year. We are humbled by the trust our patients have placed in us, and proud that we can continue to deliver the latest and best care available.

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Published by Cape Cod Healthcare, 2017-12-22 11:32:45

CCHC Cancer Annual Report

The Cape Cod Healthcare Regional Cancer Network (CCHCRCN) brings together a team of specialists working collaboratively to deliver this exciting new array of treatment options to our patients.
is report goes into more detail about our accomplishments over the last year. We are humbled by the trust our patients have placed in us, and proud that we can continue to deliver the latest and best care available.

Keywords: Cancer, data, report, statistics

Cancer Services and Treatments
What the Experts Cancer Treatment are Saying Statistics
AnnuAl report
Cape Cod Hospital and Falmouth Hospital regional Cancer network – 2016
CAPE COD HEALTHCARE


CCHC Regional Cancer Network


“Cape Cod Healthcare Medical oncology and radiation oncology collaborate closely, communicate freely, and truly enjoy working together.” – Jennifer Crook, MD and Basia McAnaw, MD
Chiefs of Oncology
Cancer is still the number one cause of death in Massachusetts and 22 other states in the U.S. But the good news is that we are slowly but surely making headway against this disease. While there will be 1.7 million new cases diagnosed in the U.S. this year, the risk of an American dying of cancer has actually decreased by 25 percent over the last 25 years.
At Cape Cod Healthcare, we have seen and been a part of this promising trend. is is due to a number of factors, such as healthier lifestyles, including smoking cessation, improvements in screening and improvements in medical, surgical and radiation oncology treatments. It is extremely gratifying to know that we who work in the cancer eld on Cape Cod have the skillsets, technology and administrative support necessary to ensure that our patients can bene t from these advances.
Over the last 25 years, cancer treatment has progressed by leaps and bounds. Today, two of three people with cancer live at least ve years a er diagnosis, and the quality of their lives is much better. Our ability to manage adverse side e ects allows many patients to continue with their daily routines during treatment.
Advances in medical and radiation oncology allow us to now tailor more treatments based on the genomic pro le of tumors. In medical oncology, nothing has been as transformative as the evolution of immunotherapy drugs, which trigger the body’s own immune system to destroy tumors. We are seeing more and more immunotherapy drugs arriving on the scene, which will enable us to treat many kinds of cancer with more targeted drugs.
Radiation oncology has advanced to the point where more powerful treatment can be given with better precision, sparing as much healthy tissue as possible. is has allowed us to save more lives and deliver fewer side e ects to a great many of our patients.
In other areas of cancer care, radiology advancements in PET-CT, digital and tomosynthesis mammography, and MRI imaging allow us to nd more tumors when they are in an early stage. In pathology, specialized testing helps to e ectively identify and treat cancer, based on its genetic pro le. In surgery, the emergence of minimally invasive techniques minimizes recovery time and retains cosmetic appearance for more and more patients, while e ectively removing all traces of cancer at the same time.
e Cape Cod Healthcare Regional Cancer Network (CCHCRCN) brings together a team of specialists working collaboratively to deliver this exciting new array of treatment options to our patients. We work closely with specialists at Dana-Farber Cancer Institute and Massachusetts General Hospital. Specialists from these institutions participate in CCHCRCN weekly tumor boards and second opinion clinics, expanding the clinical oversight we o er to our patients.
is report goes into more detail about our accomplishments over the last year. We are humbled by the trust our patients have placed in us, and proud that we can continue to deliver the latest and best care available.
Jennifer Crook, MD and Basia McAnaw, MD | Oncology
2016 Annual Report | 1


Screening examinations are tests performed to nd disease before symptoms begin. The goal of screening is to detect disease at its earliest and most treatable stage.
Screenings
Anne Morris, MD
3D Mammography/Tomography
Advanced imaging leads to advanced detection. Cape Cod Healthcare continues to provide the latest technology in breast care with 3D Mammography available at all three of our breast imaging centers: Cuda Women’s Health Center in Hyannis, Seifer Women’s Health and Imaging Center in Falmouth, and the Fontaine Outpatient Center in Harwich.
3D Mammography provides an enhanced view of the breast, when compared to traditional 2D imaging, allowing physicians to evaluate breast tissue layer by layer. is enhances ne details – like possible tumors – making them more visible on imaging. 3D Mammography is proven to detect 41 percent more invasive breast cancers and reduce the number of false-positive scans by more than 40 percent compared to 2D screenings alone.
Lara Lyn Bryan-Rest, MD
By detecting breast cancer as much as 15 months earlier than traditional imaging, it can be treated more rapidly and with bet- ter results. e 3D exam follows the same process as a traditional mammogram, but instead of viewing breast tissue as a at image, physicians can view “slices” – layers of breast tissue – that uncover features otherwise hidden by tissue above or below. As a result, 3D Mammography has become the breast cancer screening tool of choice.
Breast Magnetic Resonance Imaging (MRI)
Cape Cod Healthcare o ers a variety of Breast MRI options to meet the speci c needs of each patient.
Breast MRI is most o en used as a diag- nostic, rather than a screening option.
MRI can tell us functionally how a lesion
is behaving as the images re ect the tumor’s molecular/genetic characteristics. MRI does not use radiation, cannot induce cancers, and is exceedingly safe even though it does require intravenous contrast. MRI cre-
ates a “blood ow map,” detecting tumor neovascularity and peritumoral in amma- tion, making it highly sensitive. Diagnostic Breast MRI is available at both breast imag- ing centers at Cape Cod Healthcare: Cuda Women’s Health Center in Hyannis, and Seifer Women’s Health and Imaging Center in Falmouth.
2 | Cape Cod Healthcare Regional Cancer Network


“the implementation of breast tomosynthesis, or 3D mammography, is very exciting. this new technology is allowing us to be better at breast cancer detection, while decreasing the number of patients called back for further screening.”– Kenneth Caswell, MD
FAST MRI is available as a supplemental breast cancer screening option for some women. is accelerated imaging is highly e ective in detecting breast masses, particularly
in patients with dense breast. Cape Cod Healthcare was the rst healthcare system in Massachusetts to perform FAST Breast MRI. e service is available at the Cuda Women’s Health Center in Hyannis and will be coming to the Seifer Women’s Health and Imaging Center at Falmouth Hospital in 2018. is screening provides high-resolution images at
a fraction of the time and cost of a traditional MRI. Painless and radiation-free, FAST MRI takes just three to ve min- utes to perform, versus the 40 minutes of a traditional MRI, and it provides a series of images that can show a detailed view of the breast. FAST MRI can be performed in between routine mammograms or as a companion screening to a routine mammogram. FAST Breast MRI is not covered by most insurance companies, and may not be right for every- one. Women are encouraged to discuss all breast screen- ing options with their healthcare practitioner to determine which methods are best for them.
Some conditions bene t from a higher level of sensitivity.
3 Tesla (3T) Magnetic Resonance Imaging, available at the Wilkens Outpatient Medical Complex in Hyannis, o ers such an option. is high-magnetic eld 3 Tesla MAG- NETOM Verio MRI o ers enhanced views of the brain, spine, breast, prostate, and particularly the vascular system, a bene t unreachable by less powerful MRIs. is ability may allow a 3T angiogram scan to replace invasive vascular testing, like diagnostic catheter procedures. e 3T MRI at Wilkens Outpatient Medical Complex o ers whole-body coverage, minimizing the need to reposition a patient for multiple scans and, with its open bore design, the scan-
ner allows patients more room and greater comfort for the duration of the exam.
Lung Cancer Screening
e goal of screening is to detect disease at its earliest
and most treatable stage. In lung cancer screening, individuals who have a high risk of developing lung cancer, but no signs or symptoms of the disease, undergo low-dose computed tomography (LDCT) scanning of the chest. LDCT produces images of su cient quality to detect many abnormalities using up to 90 percent less ionizing radiation than a conventional chest CT scan. e typical radiation dose is equivalent to screening mammography, or ve chest X-rays.
Who is a candidate for screening?
e U.S. Preventive Services Task Force (USPSTF) recommends
annual screening for
lung cancer for those
who meet the follow- ing criteria:
• Have a history of
heavy smoking
• Smoke now or
have quit within
the past 15 years
• Are between 55
and 80 years old
Heavy smoking
means a smoking history of 30 pack-years or more. A pack-year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have
a 30 pack-year history by smoking one pack a day for 30 years or two packs a day for 15 years.
2016 Annual Report | 3


As is the case on Cape Cod, the most common types of cancer in the U.S. are: breast, lung and bronchus, prostate, colon and rectum, and bladder cancer, according to the National Cancer Institute.
Genetic and Familial Screening
Maintaining good health requires planning and care, including understanding a patient’s risk of developing malignancy. Cape Cod Healthcare is committed to being proactive in identifying those patients whose risk for cancer might be increased in comparison to the standard popula- tion risk. Our physicians have access to the best evaluation tools available. We o er two modalities of risk assessment to patients who might carry such an increased risk. ese include a careful assessment of family cancer history, as well as genetic screening for those individuals whose personal and family history suggest a predisposition for cancer.
Review of Familial Risk
In assessing familial risk, patients will meet with a provider who will carefully elicit a detailed history of cancer occur- rences within the family. is includes a detailed medical history of rst- and second-degree relatives. If the history assessment indicates that a patient might be at high risk, further testing is then o ered. Proactively suspecting an elevated risk of cancer helps both physicians and patients plan a long-term approach to health, both with regard to genetic testing, as well as to the initiation of any applicable screening programs.
Genetic Cancer Screening
ose patients whose personal and family history indicates the possibility of an elevated cancer risk can then undergo genetic testing, a er a detailed discussion with their provid- er. Testing is o en provided with a multi-gene panel, which can identify elevated risk for eight di erent cancers. ese cancers include breast, ovarian, gastric, colorectal, pancre- atic, prostate, endometrial, and melanoma skin cancers. e provider may also recommend more limited testing, de- pending upon the outcome of the history taking. Cape Cod Healthcare’s approach to risk assessment can lead to earlier detection and improved outcomes for cancer patients.
4 | Cape Cod Healthcare Regional Cancer Network
High risk Genetics Screening program
Since its beginning in 2015, Cape Cod Healthcare’s High Risk Genetics Program has screened almost 60,000 patients for risk factors that may indicate a genetic predisposition for breast cancer. Available at both the Cuda and Seifer Women’s Health Centers, the High Risk Genetics Program has identi ed over 10,000 women with higher risk for breast cancer, more than 1,000 of whom have received genetic testing.
Nearly 450 of the patients who were tested were found to be “high-risk negative.” Each has had an individualized surveillance plan created based on American Cancer Society guidelines which includes an enhanced follow-up imaging schedule. Positive genetic ndings were discovered in 9.6 percent of those tested (107 patients.) Those patients were referred for consultation related to risk-lowering options from hormone-blocking medication to prophylactic mastectomy.


Patricia’s Story
Patricia Wright has a positive attitude and a strong faith that everything works out when there are bumps in the road. These attributes helped her get through her recent breast cancer diagnosis and motivated her to get the word out about the good care she received at the Cuda Women’s Health Center and Cape Cod Hospital.
After a routine annual mammogram and follow-up imaging showed a pair of cysts that seemed suspicious after biopsy, Wright was referred to Kathryn Dalton, DO, FACS a surgeon at Cape Cod Hospital who also sees patients at the Cuda Women’s Health Center.
Her apprehension at her rst visit subsided when Dr. Dalton personally came out to greet Wright in the waiting room. “I couldn’t believe that she came out to get me for my appoint- ment,” said Wright.
Dr. Dalton explained that she would be doing a lumpectomy. And there was an opportunity for Wright to be the rst patient to have the surgery with the assistance of a new system, Savi-Scout, a radar localization system that helps make lumpectomies more precise and ef cient by guiding the surgeon to the area of a lumpectomy tumor using tiny, implanted receptors and imaging instead of using pre-operative wires, usually placed days ahead of the surgery.
Wright arrived at the hospital at 9 a.m. for placement of the Savi-Scout receptors on the day of her surgery. “It was painless,” said Wright. Dr. Dalton would determine the area of lumpectomy with an external wand using radiofrequency to communicate with the receptors.
Wright appreciates the great care she received at the Cuda Women’s Health Center and Cape Cod Hospital.
“When I went into surgery, I was not as upset as I normally would be and I think it was because Dr. Dalton gave me con dence to do this,” said Wright. “I knew she would take care of me.”
2016 Annual Report | 5


Microwave Ablation, individualized medical oncology treatments
and Hidden ScarTM breast cancer surgery are among the advanced, progressive treatments in cancer care available at Cape Cod Healthcare.
Treatments
Microwave Ablation
It is the latest in tumor treatment. Micro- wave Ablation is a fast, precise treatment for tumors, in some patients. It is minimally invasive and is performed as a same-day procedure. During the treatment, a small probe is inserted through the skin, guided to the target, and location is con rmed
with imaging. Electromagnetic waves are delivered through the probe — heating
the target area to >60°C and killing the tissue. When the ablation is complete, the physician slowly removes the probe and places a small bandage over the site of the insertion. e process takes between 1 to 2 hours, with only 5 to 10 minutes of active microwave ablation time. And because it is less invasive than other treatments, there is less discomfort and normal activity can be resumed quickly.
Damian E. Dupuy, MD, FACR
Radiation Oncology
Radiation is one of the most successful tools for detecting and treating cancer. It’s used to destroy tumors, relieve symptoms, increase survival and improve quality of life. With advanced radiation treatment close to home, our Regional Cancer Network gives you access to the same level of radiation imaging and treatment therapies found at academic medical centers, with the bene t of personal care, right on Cape Cod.
External Beam Radiation erapy (EBRT)
Radiation therapy delivered outside the body is called External Beam Radiation erapy. EBRT targets powerful X-rays to destroy tumors while minimizing injury to surrounding tissues. Cape Cod Healthcare invests in the latest EBRT technology:
• Image Guided Radiation erapy (IGRT) – Delivers radiation directly to tumors with remarkable precision through the use of real-time imaging.
• Intensity Modulated Radiation erapy (IMRT) – Treats tumors from multiple directions with moving apertures to de- liver higher radiation doses with minimal side e ects.
• Stereotactic Radiosurgery (SRS) – Focuses high-power radiation on a tumor in one session. Primarily used for brain and lung tumors, this non-surgical procedure uses a precisely mapped coordinate system
to destroy the target without harming nearby healthy tissue.
Radiation Oncology
Molly Sullivan MD
6 | Cape Cod Healthcare Regional Cancer Network


“We are entering the era of immunotherapy, where effective treatment with generally less toxicities can be used to treat more and more patients. this translates into patients not only living longer, but having a better quality of life.” – Jaclyn Flanigan, MD
• Stereotactic Body Radiation erapy (SBRT) – Similar to SRS, SBRT focuses on tumors outside the central nervous system, such as the lung, liver and prostate.
• Super cial Radiation erapy - For the treatment of skin cancers and benign so tissue conditions, we use a dedicated machine that is designed to deliver radiation treatment to the surface of the skin.
For SRS and SBRT, we use the TrueBeamTM radiosurgery system, known for its speed and precision in helping physi- cians manage complex cancers.
Brachytherapy
Brachytherapy is a type of radiation delivered inside the body through radioactive seeds or sources placed in or near the tumor. Brachytherapy provides a precise dose of radiation to the cancerous tissue while reducing radiation exposure to the healthy tissues around it
• High-Dose Rate (HDR) – Delivers radiation in controlled doses through a surgically placed applicator. HDR re- duces the number of treatments from 30 to 10 when used for indicated, early-stage breast cancers. It is also used to treat gynecological cancers.
• Prostate Seed Implants – Treats tumors through radioac- tive seeds inserted into the prostate. e low-dose radia- tion dissipates between 6 and 12 months, slowly killing the tumor with few side e ects and a high cure rate.
You’ll be cared for by a dedicated team of radiation experts, including board-certi ed physicians, nurses with advanced oncology training, radiation therapists, physicists, do- simetrists and social workers, all focused on your care and well-being. Specialists from Dana-Farber Cancer Institute partner with our team for consultations and second-opin- ion services.
Medical Oncology – Chemo, Biologic and Hormonal erapies
Medical oncology treats cancer using medicine and medical therapies alone, or in conjunction with surgical or radiation therapies. Medical oncologists diagnose and stage cancer and recommend and implement treatment. Treatments and services include:
• Chemotherapy – Uses drugs to target and kill cancer cells
• Biologic erapy – Also called immunotherapy, harnesses
the body’s immune system to ght cancer or lessen the
side e ects of treatment.
• Hormonal erapy – Alters the body’s hormone levels to
a ect tumor growth in a hormone-sensitive cancer, such
as breast or prostate cancer
• Blood and Platelet Transfusions
• Investigational erapy
• Management of Chemotherapy-Related Symptoms
Monitoring and Managing Side E ects
Everyone responds di erently to medical therapies, and you may not experience the same side e ects as others. Your team will seek to minimize side e ects and actively help you manage symptoms. We also have a full suite of support services to help maintain your quality of life.
Your Care Team
A specially trained team of medical oncologists, on-site pharmacists, oncology-certi ed nurses and hematology specialists will collaborate on your care, monitor your progress and celebrate your recovery. We partner with and regularly consult with oncologists at Dana-Farber Cancer Institute in Boston.
2016 Annual Report | 7


The da Vinci® Surgical System is an advanced technology used in robotic-assisted surgical procedures. Cape Cod Healthcare’s investment in the latest technology and training bene ts our cancer care.
Surgeries
Surgical Oncology
Surgery is used to remove tumors and prevent cancer from spreading or returning. Surgery is also a diagnostic tool. It’s used
to biopsy tissue, diagnose cancer and stage the extent of the disease. In addition,
cancer surgeons implant treatment devices, perform reconstructive procedures and as- sist with pain management.
Minimally Invasive Cancer Surgery
Our surgeons train in the latest techniques, including less invasive procedures that
use smaller incisions and lead to a faster recovery. ese procedures include radio- frequency ablation using laparoscopy and image-guided assistance to treat tumors, as well as microwave ablation. We also per- form robotic surgery using the da Vinci® Surgical System to treat thoracic cancers, as well as those of the prostate and uterus.
oracic Surgery
oracic surgeons are committed to the prevention, diagnosis and treatment of diseases in the chest cavity. ey perform surgery on the lungs, esophagus and other organs and tissues in the chest. At Cape Cod Healthcare, our thoracic surgeons are experts in their eld with a long-standing practice of minimally invasive thoracic surgery, including robotic surgery. As members of a highly collaborate interdis- ciplinary team they ensure your care is tailored to meet your speci c situation. Our Regional Cancer Network physicians are highly skilled and trained, and use the latest technology to make sure you get the best treatment.
Conditions we treat include:
• Lung cancer
• Esophageal cancer
• Benign diseases and tumors of the lungs
and esophagus
• Emphysema
• Myasthenia gravis • Pleural diseases
Jill Oxley, MD, FACS
8 | Cape Cod Healthcare Regional Cancer Network


“Hidden ScarTM breast surgery removes the cancer
and leaves the breast to look essentially untouched.”
– Kathryn Dalton, DO, FACS
Plastic and Reconstructive Surgery
e board certi ed plastic surgeons at Cape Cod Hospi- tal specialize in the overall treatment of skin cancers and in the reconstructive process following the treatment of breast cancer patients.
Kathryn Dalton, DO, FACS and Jill Oxley, MD, FACS
are two of only ve surgeons in Massachusetts certi ed
in Hidden Scar Surgery. Cape Cod Hospital is the only hospital in the state to be certi ed as a Hidden Scar Center of Excellence.
Pathology
Most cancer patients never meet their pathologist, but pathologists are a vital, active member of our multi- disciplinary cancer care team. A pathologist is a medical doctor who is o en referred to as the “doctor’s doctor”, as most of their day-to-day interactions regarding patients are with other physicians. Pathology is the study and diagnosis of disease. Community Hospital pathologists, such as ours at Cape Cod Healthcare, focus primarily on tissue diagnosis. A er graduating from medical school, pathologists undergo at least 4 additional years of specialty training. Our pathologists have extensive training and experience and are certi ed by the American Board of Anatomic Pathology.
Acting behind the scenes, pathologists determine whether that dark freckle you found on your skin is concerning, whether the abnormality on your mammogram is cancer, or whether your Pap smear shows pre-malignant chang- es. Although these may seem to be determinations that could be made by a machine or computer, the practice of medicine and pathology is much more complex. A er a diagnosis of cancer is made, pathologists make additional analyses of tumor type, where it came from, whether it has spread, as well as other subtle tumor ndings which help determine therapeutic decisions. At our weekly multi-dis- ciplinary tumor board conference meetings, pathologists present pathologic ndings and interact directly with other doctors involved in cancer care to help create a compre- hensive and individualized treatment plan for each patient.
Our goals in breast reconstruction are to restore either one or both breasts to a near normal appearance a er the vari- ous treatments available for breast cancer patients, includ- ing lumpectomies and mastectomies. We focus on the overall size, shape, and appearance of the breasts and if the mastectomy is one sided then we also focus on whatever procedure is necessary for the other side to give the best symmetry possible.
As plastic surgeons we also play an important role in the treatments of skin cancer. We understand that the surgical removal of skin cancers may result in scars or dis gure- ment, but by using specialized techniques we work hard to remove the malignancies without creating severe changes to your appearance. We work with all the local dermatolo- gists in the overall treatment plan for our patients.
Hidden ScarTM Breast Cancer Surgery
When surgery is required to treat breast cancer, Cape Cod Healthcare’s expert physicians are at the forefront of providing the most advanced procedures, focused on treating the whole patient.
Were the rst in Massachusetts to o er Hidden ScarTM Breast Cancer Surgery, an advanced approach to breast cancer care. In Hidden Scar surgery, a single incision is made along the natural folds of the skin to remove can- cerous tissue, sparing the nipple, areola and surrounding breast tissue.
is procedure minimizes scarring and helps to preserve the natural breast shape, with the aim of preserving a woman’s physical appearance and minimizing the emo- tional impact of breast surgery.
2016 Annual Report | 9


Cape Cod Healthcare is committed to supporting patients throughout the diagnosis, treatment and recovery process. From social services to integrative and palliative care, we provide the resources to help patients and their caregivers every step of the way.
Support Services
Social Workers for
Personal Support
Our social workers are here to help with:
• Health insurance coverage questions and approvals
• Medication programs
• Disability and family leave procedures
• Counseling and crisis intervention
services
• Transportation to and from the hospital
We also work closely with the Visiting Nurse Association of Cape Cod to identify home health and other support services, as needed.
Dealing with the Psychological
Impact of Cancer
A diagnosis of cancer can have a profound e ect on a person. In addition to the physi- cal e ects of the disease, many have psycho-
Jeffrey Gaudet LICSW OSW-C
logical e ects that bene t from treatment. Lack of social support systems, concerns about intimacy and body image, pain,
and uncertainty all contribute to psycho- logical distress, leading to depression in
an estimated 16 to 25 percent of cancer patients, while many others struggle with anxiety, anger and fear. As a result, patients can become isolated by the fear caused by their diagnosis, treatment and prognosis generate.
e Davenport-Mugar Cancer Center has expanded its partnership with Cape Cod Hospital’s Behavioral Health Services to secure onsite psychiatric services for our cancer patients. John Bertera, PhD is a clinical psychologist who specializes in dealing with the aspects of cancer care that can interfere with full participation in medical therapies. He is now available weekly to see patients at the cancer center. e addition of Dr. Bertera to our care team provides support to our patients in a convenient and familiar setting.
Financial Assistance Program
Cape Cod Healthcare provides an oncology nance manager to work exclusively with patients facing cancer treatment to coun- sel them on the nancial considerations
of their medical care plan. Our oncology nancial manager provides patients with clear, practical guidance during a stressful time, helping patients navigate their com- plex medical care.
e oncology nance manager will review the clinician’s course of treatment alongside
10 | Cape Cod Healthcare Regional Cancer Network


“Developing a plan of care that is meaningful requires much more than a diagnosis. It requires that we know what truly matters to you.” – Don Guadagnoli, MD
the patient’s health insurance plan to determine a clear pic- ture of coverage and will counsel the patient about which services are covered by insurance and those that would
fall outside the scope of coverage as an out-of-pocket cost, providing patients with the information they need to make the best nancial decisions regarding their care.
Our oncology nance manager can develop a payment plan for patients, if needed, and for quali ed patients, will seek out alternative sources of funding from charitable, philan- thropic and other institutions. For more information, call Cancer Services at 508-862-7575.
Supporting Decisions along the
Continuum of Care
In 2015, Cape Cod Healthcare embarked on the Quality of Life Initiative, a community-wide mission to support patients across the continuum of care. Our goal is to have every competent adult on the Cape discuss what most matters to them with their loved ones and caregivers and to ll out a healthcare proxy naming an agent to carry out their care wishes.
e Honoring Choices MA Getting Started tool kit is only provided to individuals with a guided conversation by one of the two trained social workers in the Davenport-Mugar Oncology Center, to ensure understanding of the planning process.
Physicians and clinical sta have been provided Continu- ing Medical Education over the last year to implement and guide goals of care conversations with patients and families. e aim is to start conversations sooner rather than later in the course of an illness.
e Quality of Life program extends into the community and involves physicians, nurses, clergy, emergency medi- cal technicians (EMTs), attorneys, and community-based social service organizations.
Hospice & Palliative Care
Hospice services at VNA of Cape Cod provide compassion- ate care and support to patients and families facing a terminal illness. is trained, interdisciplinary team, guided by a medical director, provides the best possible care to hospice patients and their families.
• Registered nurses provide case management including pain and symptom management, patient and family education and equipment assessment.
• Medical social workers address the need for emotional and psychological support, and provide information and assistance with nancial and caregiving issues and alternative placement needs.
• Homecare aides provide personal care for patients and light homemaker services.
• e spiritual coordinator/chaplain addresses spiritual needs and supports for the patient and family.
• erapies (physical, occupational, speech and nutrition) are o ered to ensure quality of life, independence and safety.
• Trained and supervised volunteers provide respite
care, clerical support, o en help with errands and assist patients and families.
• A bereavement program is managed by a counselor specializing in meeting the needs of the family for the rst year following the patient’s death through visits, telephone conversations, mailings, and information on support groups.
• e hospice medical director teaches and advises the hospice team and consults with patients’ attending physicians when requested.
2016 Annual Report | 11


“Hospice is about bringing calm, dignity and hope to patients and families. We have the privilege of walking this journey with them.”
– Pamela McPherson RN, BSN, MA CHPN
and Erin McGee, RN, BSN - VNA Hospice Care Clinical Liaisons
Palliative care services also are available for patients while continuing with curative treatments to improve quality
of life through pain and symptom management, and education, addressing all needs presented by the illness. Team members assist patients and families with end-of-life decision-making and advance care directives.
To nd out more, call 800-978-0838 or 508-957-7710.
Survivorship Program
e survivorship program at Cape Cod Healthcare provides emotional and psychological support to you and your family and helps you plan for a life beyond cancer through a variety of classes and support group opportunities.
Help for Patients & Families
Some of the ways we help include: • Individual counseling
• Education about cancer
• Guidance on nutrition and tness
• Information about complementary and alternative medicine
• Connection with cancer survivors, support groups and community resources
• Programs and resources through the American Cancer Society
Our services don’t end when treatment does. You can count on us for support with post-treatment services, guidance on managing the risk of second cancers and resources for leading a full and healthy life.
Rehabilitation erapies
Many patients with cancer su er functional limitations which can impact the quality of everyday life. Cape Cod Healthcare provides rehabilitation therapies to prevent and treat such limitations through their Physical erapy, Oc- cupational erapy and Speech erapy programs.
Common conditions caused by cancer and cancer treat- ment that may bene t from therapy include the following. • Lymphedema: Swelling, usually in the arms or legs,
caused by a blockage in the lymphatic system o en caused by the removal of lymph nodes during breast cancer treatment.
• Fatigue: Occupational and Physical therapists can teach energy conservation techniques.
• Deconditioning: Restoring physical function from reduced activity due to illness, pain, surgery or other treatments to regain active lifestyle and prevent falls.
• Chemotherapy-induced peripheral neuropathy: erapy to adapt activity when a feeling of numbness or tingling in the extremities occurs a er treatment.
• Speech erapy: Helps restore speech and swallowing following head and neck cancer treatment.
In addition to one-on-one treatment, our rehabilitation services also work with groups through active participa- tion in cancer support groups, providing Water Pals classes for breast cancer survivors, and through dedicated cancer rehabilitation programs.
Living Fit for You!
is free six-week exercise and education program is for cancer survivors of all ages. e program is o ered at Falmouth Hospital and provides consultation, introduc- tion to complementary therapies such as yoga and tai chi, and provides wellness coaching related to nutrition, distress management, and exercise to promote independence and provide a bridge to the structured outpatient rehabilitative environment.
12 | Cape Cod Healthcare Regional Cancer Network


By the Numbers
CApe CoD HoSpItAl
AnD FAlMoutH HoSpItAl CAnCer CenterS’
top treAtMent AreAS
In 2016, there were 1,424 analytic patients diagnosed and/or treated at CCHC.
Our top three treatment areas – Breast (25.6%), Respiratory (15.4%) and Digestive System (14.3%) make up over half of all cases (55.3%).
Of the 1424 cases diagnosed and/or treated at CCHC in 2016, 659 men were diagnosed (46.3%) and 765 women were diagnosed (53.7%).
Breast 25.6% Respiratory System 15.4% Digestive System 14.3% Urinary System 10.3% Male Genital System 9.7% Female Genital System 5.0% Skin (excluding basal & squamous) 3.7% Lymphoma 3.7% Miscellaneous 3.1% Oral Cavity & Pharynx 2.7% Brain/Nervous System 2.0% Myeloma 1.8% Leukemia 1.8% Endocrine System 1.0%
treAtMent AreAS BY GenDer
MAle # proStAte 133
%
FeMAle # % BreASt 362 47%
lunG & BronCHuS urInArY BlADDer
Colon & reCtuM non-HoDGKIn lYMpHoMA orAl CAVItY & pHArYnX MelAnoMA oF tHe SKIn KIDneY & renAl pelVIS leuKeMIA
pAnCreAS
All otHer SIteS
20% 15% 12%
99
82
58
35
32 5% 25 4% 24 4% 14 2% 13 2%
144 22%
lunG & BronCHuS Colon & reCtuM uterIne CorpuS MelAnoMA oF tHe SKIn KIDneY & renAl pelVIS non-HoDGKIn lYMpHoMA oVArY
leuKeMIA tHYroID
All otHer SIteS
102 13% 49 6% 46 6% 21 3% 15 2% 13 2% 11 1% 11 1% 10 1%
125 16%
9% 5%
Image reprinted by permission of the American Cancer Society, Inc. from www.cancer.org. All rights reserved.
2016 Annual Report | 13


Clinical trials are a scienti c and systematic way to research the outcomes of a particular drug, device or other process to see how well it works and how safe it is.
Clinical Research at Cape Cod Hospital
If you’ve been diagnosed with cancer, you’ll be reassured to know that the skills and technology found in the most advanced cancer institutions in the nation are avail- able right here on the Cape. And you’ll bene t from the things that set us apart, like personalized care from specialists
who know you by name and our clinical partnership with the Dana-Farber/Partners Cancer Care (DF/PCC) for research trials, consultations and second opinions.
Trials are sponsored by DF/PCC, national cooperative groups, or industry groups. All patients enrolled in studies are overseen by an oncology research nurse in addition to the principal investigator. Patients who may bene t from, or be appropriate for a clinical trial are identi ed by the oncology team, o en during tumor boards as the treatment plan is discussed.
Peter S. Hopewood, MD, FACS
Two exciting studies are currently under- way. Utilizing FitBit technology, the rst evaluates the role of weight loss in adjuvant treatment of overweight and obese women with breast cancer. e second study is a double-blind placebo controlled trial of As- pirin as adjuvant therapy for node positive, HER2 negative breast cancer.
There is only one national association which assures Quality Cancer Care
– the Commission on Cancer. The cancer programs at Cape Cod and Falmouth Hospitals have been con- tinuously certi ed by this Commission for over 10 years. Our mission is to measurably improve cancer survival and the quality of that survival or survivorship. During 2017 both pro- grams have joined forces to become
a stronger and a more comprehensive integrated cancer network for the bene t of our patients and families.
14 | Cape Cod Healthcare Regional Cancer Network


Regional Cancer Network
Accreditations
At Cape Cod Healthcare, our belief in a comprehensive cancer program that addresses the individual patient is evident in the exceptional care we provide every day.
Our integrated cancer program, consisting of Cape Cod Hospital’s Davenport Mugar Hematology/Oncology Center and Falmouth Hospital’s Clark Cancer Center, is accredited by the American College of Surgeons Commission on Cancer. The Cuda Women’s Health Center at the Wilkens Outpatient Medical Complex in Hyannis and the Seifer Women’s Health and Imaging Center in Falmouth are accredited by the American College of Surgeons’ National Accreditation Program for Breast Centers, and by the American College of Radiology. Our Pathology program is certi- ed by the College of American Pathologists.
Each certifying body requires demonstration of compliance with national standards of care to provide multimodality care plans for each individual patient based on evidence-based guidelines and practices. Our team is made up of dedicated board-certi ed medical and radiation oncologists, nurses, pharmacists, social workers, radiation therapists, physicists, dosimetrists, tumor registrars, medical assistants, clerical staff and volunteers who work together to provide state-of-the-art care in a bright and emotionally supportive atmosphere.
Cape Cod Healthcare is af liated with many distinguished cancer treatment centers and organizations, including the National Cancer Institute, Dana-Farber/Partners Cancer Care, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Massachusetts General Hospital. Through our collaborative
and innovative approaches to cancer care and prevention, Cape Cod Healthcare provides exceptional treatment to those with cancer in our community.
2016 Annual Report | 15


Cape Cod Healthcare’s commitment to our patients extends beyond medical treatment. We reach out to the community to support patients’ wellness through complementary services, community education, clinical training and support for those undergoing treatment.
Community Collaboration
Cape Wellness Collaborative
Cape Cod Healthcare has partnered
with the local non-pro t Cape Wellness Collaborative (CWC) to provide integrative therapies for cancer patients, free of
charge, through the funding and distribu- tion of Cape Wellness cards. ese gi cards allow patients to take part in acupuncture, yoga, art therapy, chiropractic services, massage therapy, reiki, nutrition therapy and energy support through the Cape Wellness Collaborative.
ese services are available to patients un- dergoing any type of cancer care, including surgery, radiation or chemotherapy or dur- ing survivorship, if su ering from lasting e ects of their care. e therapies promote a greater sense of well-being and can help treatment symptoms like nausea and anxiety, according to the National Center for Complementary and Integrative Health.
Patients are admitted to the CCHC-CWC program by a self-referral or practitioner referral and are o ered education about the services o ered. CWC then connects the patient to the appropriate practitioner for treatment. Learn more about the Cape Wellness Collaborative at www.capewell- nesscollaborative.org.
Dancing with the Docs
Dancing with the Docs Cape Cod is a gala and dance competition in which Cape Cod Healthcare physicians are paired with local ballroom dance professionals to compete for top dance honors. e formal, black-tie event and live auction is a fundraiser for Cape Wellness Collaborative (CWC), a local nonpro t that gives free complementary, integrative therapies (including massage, acupuncture, Reiki and nutrition counsel- ing) to people with cancer.
Cape Cod Healthcare oncology patients bene t from complementary treatments through the Cape Wellness
Collaborative to ease fatigue, pain and the emotional e ects of treatment.
is popular fundraiser will return in February 2018. For more information about Dancing with the Docs, visit
www.dwtdcapecod.com.
C. Patricia Fater, MD
16 | Cape Cod Healthcare Regional Cancer Network


“We offer a variety of options for reconstruction after a complete or partial mastectomy, including reconstruction using breast implants, your
own natural body tissue or a combination of both.” – Michael Loffredo, MD
e Breast Cancer Reconstructive Surgery Fund
rough a generous grant from an anonymous donor, Cape Cod Healthcare can now provide nancial assistance to women facing breast reconstruction surgery.
e Breast Cancer Reconstruction Surgery Fund is available to women who live in Barnstable County, to help with the costs of breast reconstruction not covered by insurance, in- cluding, without limitation, deductibles, co-payments and/ or all surgical costs for women who have had all or any part of either or both breasts removed due to a cancer diagnosis. e funds are available on a rst-come, rst-served basis.
is year, the Breast Cancer Reconstructive Surgery Fund totals $50,000, which will be administered by the Cape Cod Foundation and has been awarded to Cape Cod Healthcare. For more information, contact Je Gaudet, Survivorship Program Manager at Cape Cod Healthcare at survivors@ capecodhealth.org.
e Marjorie Sherley Garth Wolcott Nursing
Endowment Fund at Cape Cod Hospital
is fund was established in 2003 by Marjorie Sherley Garth Wolcott to bene t the professional training of the nursing sta in Cancer Services. is year’s bene ciary was Emily Gomes, RN, of the Cape Cod Hospital Oncology Department, who continued her education through course- work that would develop her professional skills.
Gi s are accepted to the Marjorie Sherley Garth Wolcott Nursing Endowment Fund through the Cape Cod Health- care Foundation at www.capecodhealth.org/give-to-cchc.
Team Maureen
Cape Cod Healthcare and the CCHC Cancer Committee have collaborated with Team Maureen since 2014 to edu- cate the public about cervical cancer and human papilloma- virus (HPV) prevention. In
addition to CCHC’s continuing sponsorship of Team Maureen’s annual Run for Your
Life run/walk, the CCHC Community Bene ts program and Cancer Committee collaborated on a new community outreach e ort with Team Maureen in 2017. e
goal was to create a teen-friendly, parent-friendly video on the long-term and o en deadly e ects of HPV infec- tion. e video was presented to the public on the Team Maureen and the Cape Cod Healthcare websites and has received over 1600
viewings to date. To watch the video or send it to a friend, go to https://www.capecodhealth.org/care-treatment/can- cer/hpv-prevention.
American Cancer Society Compass of Hope
e American Cancer Society Compass of Hope Gala is
a fundraiser that bene ts cancer patients, survivors and research, including many patients of Cape Cod Healthcare. Among those recognized at the 2017 event was medical honoree Daniel Canaday, MD, a radiation oncologist at Davenport-Mugar Cancer Center at Cape Cod Hospital and Clark Cancer Center at Falmouth Hospital.
Funds from this annual gala have supported “ e Road to Recovery,” a program in which volunteers drive patients to and from appointments, as well as the “Look Good, Feel Better” support groups and virtual online support groups available to Cape Cod Healthcare patients.
2016 Annual Report | 17


Betsy’s Story
Betsy Reney of Hyannis knows the true meaning of survivorship. At 67, she has faced her own mortality more than once and has survived it with determination and a positive outlook on life.
“I happen to be the president of the 100-percent survivor’s club and anyone who wants to join can for free,” said Reney with a glint in her eyes. “I’m calling
it that because I have had enough in one lifetime to last a lifetime.”
Two bouts of cancer and a roof collapse that almost killed her were pivotal moments in her life. Reconstruc- tion, time and endurance helped her to heal.
Her rst cancer diagnosis occurred when she was only 25 years old and the mother of two very young children. Then in 1995, Reney was working at Staples in Hyan- nis when part of the roof collapsed on top of her.
“Cape Cod Hospital saved my life,” said Reney.
Years later, she was diagnosed with Stage I breast cancer that had not spread to her lymph nodes.
She would need a mastectomy but she was undecided about reconstruction. Once she met with Mark Fater, MD, a plastic surgeon at Cape Cod Hospital, she reconsidered, but she would need some nancial assistance with the reconstruction. The Breast Cancer Reconstruction Fund of the Cape Cod Foundation was there to help.
The fund, accessible through the Cape Cod Healthcare Foundation, is available to residents living in Barnstable County to help with costs associated with breast recon- struction that aren’t covered by insurance.
“It really did make a difference and I am glad I did it.
I would have never, ever considered altering my body, I don’t even have pierced ears,” she said. “It was the right decision.”
18 | Cape Cod Healthcare Regional Cancer Network


Locations and Services
CApe CoD HoSpItAl AnD CuDA WoMen’S HeAltH Center
2
FAlMoutH HoSpItAl AnD SeIFer WoMen’S HeAltH AnD IMAGInG Center
Screenings
FAST MRI
3D Mammography
3 Tesla (3T) Magnetic Resonance Imaging
Lung Cancer Screening Genetic and Familial Screening
treatments
Microwave Ablation
Radiation Oncology
Brachytherapy
Medical Oncology – Chemo, Biologic and Hormonal Therapies
Chemotherapy
Biologic Therapy
Hormonal Therapy
Blood and Platelet Transfusions
Investigational Therapy
Surgeries
Oncology Surgery
Thoracic Surgery
Reconstructive Surgery
Hidden ScarTM Breast Cancer Surgery
Clinical research
1
1. FH/SeIFer

• •
• •

• • •
3
FontAIne outpAtIent Center
2. CCH/CuDA
• • •
• •
• • • •
• • • •

• • • •

3. FontAIne


2016 Annual Report | 19


2016-2017 Cancer Committee Members
•Chair: Peter Hopewood, MD, FACS
• Cancer Liaison Physician: Jill Oxley, MD, FACS,
MEDICAL ONCOLOGY
•Jennifer Crook, MD
• Alternate: Phillip Wade, MD
RADIATION ONCOLOGY
• Basia McAnaw, MD
• Alternate: Jeffrey Martin, MD • Gabor Menyhart, PhD
SURGERY
•Jeffrey Spillane, MD, FACS • Alternates:
J. Keith Bleiler, MD Raymond Gagnon, MD
PATHOLOGY
•Leslie Max, MD •Salah El-Deriny, MD •Ryanna Lucas, PA
RADIOLOGY
•Michael Fishbein, MD,
Community Outreach
Coordinator
• Alternate: Alexander
Adducci, MD, PhD
ADMINISTRATION
•Rebecca Robke, RN, MSN •Barbara Archambeault, RT •Sheila Broderick, RT
RESEARCH
•Rebecca Buscanera, RN • Alternate: Christine
Davenport, RN
SOCIAL SERVICE
• Jeffrey Gaudet, LICSW
• Alternate: Carole Bernier,
MSW, LICSW
NURSING
•Shelley West, RN
• Alternate: Mary Renzi, RN
CANCER REGISTRY
• Deborah Crockett-Rice, CTR • Hester Grue, CTR
AMERICAN CANCER SOCIETY
•Angela Hall-Jones
PHYSICAL REHABILITATION
•Julie Drake, DPT •Kristine Whaples, MS,
RCEP, CDE •Elizabeth Sharp, SLP
HOSPICE AND
PALLIATIVE CARE
•Patricia Parker, RN
•Pam McPherson, RN
• Alternate: Sarah Endres, RN
QUALITY IMPROVEMENT
•Kirsten Albers, RN
MARKETING
•Jan Aubrey, RN •Patrick Kane, MBA
BREAST LEADERSHIP TEAM - Cape Cod Hospital •Kirsten Albers, RN •Rebecca Buscanera, RN •Linda Conroy
• Jennifer Crook, MD
• Kathryn Dalton, DO, FACS •Susan Fredette, RDMS •Jeffrey Gaudet, LICSW
• Hester Grue, CTR
• Michael Loffredo, MD
• Jeffrey Martin, MD
•Clara Mesonero, MD •Anne Morris, MD
• Jill Oxley, MD, FACS •Brenna Quinn, OT •Rebecca Robke, RN, MSN •Pat Ryan-Blanchard, NP
BREAST LEADERSHIP TEAM - Falmouth Hospital •Kirsten Albers, RN •Rebecca Buscanera, RN •Lara Bryan-Rest, MD
• Theodore Calianos, MD, FACS • Deborah Crockett-Rice, CTR •Nancy Ferzoco, RN •Michael Fishbein, MD
• Raymond Gagnon, MD
• Jeffrey Gaudet, LICSW
• Peter Hopewood, MD, FACS •Joanne Kilmartin
•Kristine Whaples, MS,
RCEP, CDE
•Leslie Max, MD
•Basia McAnaw, MD •Rebecca Robke, RN, MSN
20 | Cape Cod Healthcare Regional Cancer Network


You can learn more about Cape Cod Healthcare’s Regional Cancer Network by visiting www.capecodhealth.org/cancer
Or subscribe to Cape Cod Health News at www.capecodhealthnews.com
To contact our program, call:
• Cape Cod Hospital Medical Oncology:
• Cape Cod Hospital Radiation Oncology:
• Falmouth Hospital Radiation Oncology:
• Cuda Women’s Health Center:
• Fontaine Outpatient Center:
• Seifer Women’s Health & Imaging Center:
To donate, call or email:
• Phone: 508-862-5600
• Toll-Free: 800-499-3377
• Email: [email protected]
508-862-7575 508-862-5300 508-495-8900 508-957-1700 508-432-4100 877-224-2009


Cape Cod Healthcare | 88 Lewis Bay Road | Hyannis, Massachusetts 02601 | www.capecodhealth.org
CAPE COD HEALTHCARE


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