Certification of cancer centers a prestigious mark

A certification by the National Cancer Institute for one of Rhode Island’s cancer centers would mean more than just better health care.

“From a business perspective, it is good to have a clinical cancer center,” said John Fulton, an associate director of health at the Rhode Island Department of Health. “It brings federal dollars into the state for research. Depending on the nature of the research, it can also result in patents and medications that can be developed within the state. It’s good for the economy.”

NCI certification can also mean more ease in obtaining research grants and a hospital’s ability to grow in terms of staff, patients and facilities, Fulton said.

“The designation is a prestigious one,” Fulton said, and would likely involve requirements such as board-certified oncologists on staff, a well-run cancer registry, the ability to do clinical cancer research, and a demonstrated patient population.

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In theory, Fulton said, it would be possible for more than one Rhode Island hospital to obtain certification, but if, for example, the NCI had “100 meritorious applicants and the ability to fund only 50 of them, it makes sense in terms of population access to spread them out geographically.”

Having an NCI certified cancer center in Rhode Island “should be a major priority for the state,” said Robert A. Urciuoli, president and chief executive officer at Roger Williams Medical Center. “That designation brings with it the most current, up-to-date treatment modalities that are possible.”

While the incidence of cancer in the Ocean State is a on par with the rest of
the country, Rhode Island’s mortality rate is higher, and “I think we need a full-blown
effort — especially in the research side — to find out why,” Urciuoli said.

Room for improvement
Area hospitals are busy making improvements to their cancer care programs.

At Lifespan, which includes Rhode Island, Miriam and Newport Hospitals, Dr. Fred Schiffman, vice chairman of the Department of Medicine at Brown, was hired last year as clinical director for their cancer center.

Schiffman said Lifespan is striving for a multidisciplinary, cooperative approach to treating common malignancies such as lung, breast and prostate cancers. Such an approach involves a patient’s primary physician as well as a cancer team, which may include an oncologist, psychiatrist, radiotherapist, surgeon, nutritionist and a cosmetologist.

A daylong visit to one of Landmark’s clinics places a patient in touch with each of these specialists. At the end of the day, he meets with the entire team to discuss treatment and ask questions.

“We want to give them a sense of anchorage to an institution that is going to care for them in totality,” Dr. Schiffman said.

This approach is beneficial not only to patients, but to their care management team, who has the capability to consult with each other on the spot.

“The whole concept here is that we are designing this cancer treatment delivery system in a way that keeps the needs of the patients and the physicians in mind,” said Lifespan Senior Vice President of Strategic Planning John Gillespie.

Lifespan plans to spend $2.6 million at Miriam and $8 million at Rhode Island hospitals in the next one to two years to upgrade its cancer facilities.

Gillespie said 40 percent of cancer care in Rhode Island is provided at one of Lifespan’s three hospitals. In 1998, the most recent statistics available, Rhode Island Hospital treated 1,629 new cancer patients; Miriam 831; and Newport 310.

Landmark Medical Center in Woonsocket is implementing major expansions of heart and cancer treatment. The hospital has plans to build catheterization labs and operating rooms for heart surgery, and a three-story addition that will house the hospital’s new cancer center and other facilities.

The new 50,000-square-foot addition will house the cancer center, new ambulatory surgery facilities and a health/education conference center.

The cancer center will offer comprehensive diagnosis, treatment and support services for people at all stages of dealing with cancer. Its centerpiece will be a state-of-the-art linear accelerator for precise radiation therapy to eliminate cancer cells without damaging surrounding healthy tissue.

Eileen Dobbing, chief nursing officer and vice president of patient care services, said that after the projected opening of Landmark’s cardiac catheterization lab in August, the hospital hopes to begin construction on the cancer center — which is still in the developmental phase while planners determine the best layout for the building — in the fall.

“We’ve been visiting different cancer sites, evaluating what is optimal,” said Dobbing. “We’re pretty close to making decisions about the types of equipment we want to purchase.”

Landmark too will focus on the most frequently diagnosed types of cancer — breast, prostate, lung and colorectal — according to Dobbing.

Landmark holds cancer screenings each year – for which physicians and staff donate their time — in an effort to promote early detection. Last year’s on-site skin cancer clinic processed 100 people — a second clinic, a cooperative effort with WLNE ABC 6, held on three area beaches, attracted 350. In addition, the hospital also screened 320 men for prostate cancer and approximately 100 women for breast cancer.

The center recently obtained certification from the Commission on Cancer of the American College of Surgeons.

At Roger Williams Medical Center, Gerald J. Elfenbein, M.D., himself a bone marrow specialist, has been working the past two years to rebuild the hospital’s reputation in cancer treatment and research.

During the past year, the hospital has been recruiting a multidisciplinary team of physicians, surgeons, radiologists, researchers and nurse specialists.

Today, the Roger Williams cancer team includes Dr. Peter Quesenberry, who is leading programs in hematologic and stem cell applications and research.

Dr. Gary Strauss is developing a multidisciplinary lung cancer team. Dr. Strauss’s focus is on cancer control through prevention and early detection. One program under development will be a collaborative effort between the hospital and the University of Rhode Island and Boston College, targeting people in their early 20s who want to stop smoking.

Dr. Lawrence Lum is treating the hospital’s first group of breast and prostate cancer patients with activated T-cell immune therapy. Cells are removed from a patient’s own body, “fed” nutrients and allowed to divide. When the cells are returned to the body, their increased number have a high ability to kill cancer cell lines.

“It is given not instead of standard treatment, but in addition to standard treatment,” said Dr. Elfenbein, who estimated that close to 800 new cancer patients were treated at Roger Williams in 2000.

“We will never be the majority of the market share,” he said. “Our size is not going to change very much. How can we make an impact? Instead of targeting rare things, we’re targeting common things.”

Dr. Elfenbein said Roger Williams’ cancer center will focus on the top-killing cancers such as breast, prostate and lung.

According to new statistics from the American Cancer Society, 5,600 new cancer cases are expected to be diagnosed in Rhode Island in 2001. Nationally, 1,268,000 new cancer cases are projected.

Since 1990, nearly 15 million new cancer cases have been diagnosed.

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