Michelle L. Smith

Freelance Writer, Novelist, Humorist

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Cancer Treatment: A Community Approach, Health Matters, Spring 2009

Few six-letter words evoke more fear than cancer, especially when a friend or family member receives the dreaded diagnosis and we contemplate our own mortality. With newer diagnostic tools and therapeutic strategies, the approach to cancer care is trending towards a more comprehensive one.

Cancer Centers are surfacing in hospitals throughout the nation, and two such centers exist right here in our own backyard. Like Stanford and UCSF Medical Centers, they are equipped with the latest technology and a staff of medical experts who are forging the way for optimum cancer management.

Community Hospital of the Monterey Peninsula

Grant Swanson, MD, oncologist and medical director of the Cancer Center at Community Hospital of the Monterey Peninsula (CHOMP), describes the trend at the community level.

"...The broad array of offerings necessary for the management of cancer, starting with prevention, early detection, diagnosis, therapy, post-therapy survivorship, palliative care and end-of-life management ... that whole rainbow of offerings needs to be available for our patients."

CHOMP's Cancer Center was accredited in 1995 by the American College of Surgeon's Commission on Cancer as a Community Comprehensive Cancer Center, the highest designation available to a community hospital. A rigorous process of measuring practices against a nationwide gold standard evaluated nine critical areas, including prevention, patient outcomes and quality improvement. CHOMP received commendation in all nine areas and in March was recognized with the Commission's Outstanding Achievement Award.

"If you look at all hospitals in the United States, about 25 percent are accredited by the Commission on Cancer," Dr. Swanson says. "So we took that as an external validation of the quality of our program."

Equipped with private consultation and exam rooms, radiation therapy suites, a resource library and dedicated inpatient and outpatient medical oncology areas, CHOMP provides patients with the latest treatment options through the use of innovative technology and clinical trials, while allowing them to remain close to their support network.

The Cancer Center offers hospice and palliative care; complementary therapies such as guided imagery, hypnosis and acupunture; and a publication, Pulse magazine, dedicated to cancer topics. Treatment planning conferences are held twice weekly to delineate the optimum therapeutic approach for each individual.

Clincial director, Phillip Williams, RN, believes the Center's existence is intimately tied to its unique relationship with the community.

"We offer a myriad of support groups, not just to provide emotional support, but also to provide skills to our patients and their loved ones on how to manage...."

Palliative care is a crucial component in the management of cancer patients. Dr. Swanson clarifies that "helping patients with symptoms relating to their treatment or their cancer and improving their quality of life" is distinct from hospice care. CHOMP's formal palliative medicine service, launched in 2001, is now available to patients with any serious illness.

In the high-tech arena, CHOMP was the first hospital in the region to offer linear accelerator technology. Usually found only at major urban teaching hospitals, linear accelerators minimize radiation exposure to normal tissue by producing a narrowly focused beam of x-rays. Stereotactic radiosurgery, a sophisticated treatment that precisely focuses on a tumor without damaging surrounding tissue, was recently implemented and has been shown to shorten treatment duration for brain tumors.

Salinas Valley Memorial Hospital

Farther inland, Salinas Valley Memorial (SVMH) is also equipped with a state-of-the-art Comprehensive Cancer Center. A Cancer Care Committee comprised of oncologists, radiologists, surgeons and nurses, along with newer technologies, keeps the Center on the leading edge of diagnosis and treatment.

Also accredited by the Commission on Cancer (1987), the Center emphasizes prevention, detection, treatment and support while observing the Commission's stringent standards. Through its affiliation with Salinas Radiation Oncology Center (See sidebar), SVMH provides radiation therapy for its cancer patients under the guidance of radiation oncologists Esmond Chan, MD and Kevin Fisher, MD.

"We're part of the therapy arm ...," says Dr. Chan. "We provide radiation oncology therapy to Cancer Center patients and patients who are diagnosed in the hospital. We also participate in all cancer care programs, including cancer conferences, quality assurance and patient care programs."

One newer intervention is the use of Positron Emission Tomography (PET) in conjunction with computer tomography (CT). PET-CT technology utilizes separate images to pinpoint a tumor's location and reduce the need for biopsy or exploratory surgery.

Reiki, art therapy, wellness and survivorship programs are also offered through the Center.

"We're starting to see more people interested in wellness classes than they are in support groups," says Wendy Goossen, Cancer Registrar and Cancer Program Coordinator at SVMH. "People want a more positive outlook and want to see what they can do for themselves as opposed to sit and constantly talk about their cancer. ... But what sets us apart is that we do a lot of clinical trials here."

A clinical trials specialist works with oncologists and surgeons who enroll their patients into the trials. The Cancer Registry's management of an extensive data system is critical to the success of these trials.

So, with two Comprehensive Cancer Centers nearby, is there any reason to make the trek up the Peninsula to Stanford or UCSF?

"To be honest with you, I've been struck by the infrequency with which patients have wanted to leave the community," Dr. Swanson says. "But [in complex cases or those requiring specialized treatment], we'll suggest that patients go there for initial consultation so that everybody can discuss the right treatment plan .... Some treatments are not done outside the academic setting, such as bone marrow transplants or certain types of surgeries .... But our experience has been that in the vast majority of cases, there's no advantage in going to Stanford or UCSF."

Expanded options for cancer diagnosis and treatment are right here in our own neighborhoods. With a multidisciplinary approach and state-of-the-art technology, the odds are much better now that early diagnosis and therapeutic intervention will increase survival and the ability to live a healthier and more dignified life.

"There's something unique to having a hospital in a setting like this where it's just us and our community," Williams says.

"We're all in one boat together," Dr. Swanson adds. "To me, it's a sign of the level of commitment of the physicians in our community...."

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