Oncology Annual Report

In 2020, infusion worked on a quality improvement project to decrease the number of patients’ rescheduled appointments. We started to check future schedules 3-7 days prior to treatment for any needed changes to appointments to optimize the workflow of the Center.  This optimization is important to ensure patient safety by ensuring that nurses and pharmacists have the needed time to check and double check all medications and treatment plans and to be able to listen carefully to our patients. We also implemented a new scheduling software, in October of 2020 which has helped this project even further. First quarter of 2020 we had rescheduled 12% of our infusion patients. Fourth quarter of 2020 we were able to decrease our rescheduled patients to 1%! 

When combined with traditional medicine, CAM, also known as integrative therapies, can promote comfort and rest by addressing the needs of the whole person – not the illness, disease, or condition. Along with Reiki and Aromatherapy we include guided imagery, meditative practice, breathing exercises, pet therapy, and deep listening.

Integrative therapies can be very helpful to patients undergoing cancer treatment. For example, aromatherapy uses essential oils to stimulate the nerves in the nose, sending impulses to the part of the brain that controls memory and emotion, as a result the body becomes relaxed and anxiety can be reduced. We also offer Reiki which promotes comfort and rest through balancing the body’s energy centers restoring the physical, emotional, mental, and spiritual capacities of each individual while enhancing the healing process.

In 2020, the pandemic hampered our ability to provide some CAM services such as Reiki and pet therapy because of isolation procedures, so we focused on modalities such as aromatherapy and guided meditation.  

The pandemic impacted our staff greatly, and we re-focused our efforts to provide de-stressing resources to our hard working care teams.  These included creating our ‘Zen Den’ which is a space featuring soothing music, meditation videos, and comfortable lounge chairs and ‘Tranquil Tuesdays’ for staff to relax and refocus. These interventions helped our nurses and other team members rejuvenate and improve their focus on the care of our patients.

Each year the Commission on Cancer requires our program to offer prevention and screening programs, Garnet Health prides itself in going above and beyond what’s required for our community.  The cancer prevention and screening needs must be based off a community needs assessment and follow evidence based guidelines.  Each year we offer free community screenings to eligible participants for Oral, Head and Neck cancer, Skin cancer, as well as screenings for Breast and Lung cancer.  

In addition to the screenings Garnet Health is a member of the Orange County division of the New York State Cancer Consortium which is currently focused on increasing screening rates for Cervical, Breast, and Colon cancers.  In 2020 our focus was on HPV vaccination rates and decreasing HPV-related diseases.  

Each month we focus on highlighting the type of cancer that is being celebrating awareness that month with social media posts, in-house education, and education for the public.  Some other events include:

• World Cancer Day: An educational event for staff on all types of cancers, screening guidelines, and awareness events.
• National Dress in Blue Day for Colon Cancer: Annual employee dress in blue day, pictures for education and awareness on social media.
• Celebrate Life Half Marathon: The event was virtual, we supported through fundraising and raising awareness.
• Relay for Life: 2019 sponsorship, we fundraised and hosted a tent at the event with our team.  
• National Cancer Survivors Day: Garnet Health organized a drive thru parade around our hospital, staff cheered on and provided gifts for our survivors.
• Making Strides Against Breast Cancer: Garnet Health was a Flagship Sponsor of the drive thru event at Woodbury Commons in October 2020 and raised over $30,000 in donations.
• Lung Force Walk: A virtual event to fundraise and raise awareness, Garnet Health had the largest on site team (on the Garnet Health Medical Center grounds) of any of the participating teams.
• HPV vaccination education and awareness: Educational materials provided to Garnet Health Medical Group, screening rates were tracked and social media posts were created and shared in January and March.
• Garnet Health Employee Survivor event: A healing garden event to honor and celebrate our employees that are breast cancer survivors.

The COVID-19 Pandemic significantly impacted the Ray W. Moody, MD Breast Canter along with many diagnostic testing services throughout the hospital.  New York State mandated the closing of all elective testing and treatment performed at Garnet Health, which meant that no screening mammograms, ultrasounds or bone density testing was performed for almost five months. 

The majority of the breast center staff were re-deployed throughout the organization during this period, but we continued to perform diagnostic tests and biopsies.  We were very concerned about our patients not receiving routine mammograms, and as soon as these prohibitions were lifted, we welcomed back our patients to a new Breast Center with many new safety procedures including:

• Patient and Visitor Screening 
• Limiting schedules to support spacing of appointments
• Minimizing traffic into and out of the hospital
• Socially distanced waiting areas with frequent cleaning by our Environmental Services team
• Use of masks and other appropriate Personal Protective Equipment (PPE)
• Pre-procedural COVID-19 testing 

Throughout the year, our dedicated team continued to work to ensure that we continue to meet the highest standards in Breast Imaging and Breast Cancer Treatment.

• We proudly received a full three year accreditation with no deficiencies by the National Accreditation of Programs for Breast Centers (NAPBC). The NAPBC is a rigorous, voluntary accreditation for organizations who have committed to providing the highest standards of quality in providing breast care. 
• We also received the highest level of accreditation by the American College of Radiology (ACR) as a Breast Imaging Center of Excellence.  This recognizes performance in mammography, stereotactic breast biopsy (both prone (face down) and upright), breast ultrasound and ultrasound guided breast biopsies, and Breast MRI and MRI guided breast biopsies.

A number of Quality improvement projects were implements or continued through 2020.  These include:

• Participation in the New York State DOH Grants for the National Accreditation Program for Breast Centers (NAPBC) which started in 2016.  This grant provides funding for our Breast Screening Liaison who works to schedule appointments, coordinate prescriptions and provide resources to assist with uninsured or underinsured women in our community. The goal for this project is that each center reaches 600 eligible women per year.  We are proud to report that our bi-lingual liaison has reached over 4,491 women in five years, with 1,320 of whom completed their breast screening at either Garnet Health Medical Center or Catskill Regional Medical Center.
• We performed a Quality Improvement Study on Breast MRI Rescheduling which resulted in an over 35% improvement in rescheduled appointments.
• Patient Satisfaction with the Ray W. Moody, MD Breast Center was above the 90th percentile nationally on Press Ganey, our patient survey
• The Breast Center celebrated two award winners in October 2020, Dina Kamrowski BSN, RN received the “Bee Award” and our Breast Nurse Navigator Stephanie Bonanno, BSN, RN, OCN received the “Daisy Award” for October for extraordinary nurses. Their commitment, compassion and care to our patients and families goes above and beyond.    

We also continued to educate the community on the importance of Breast Screening and the dangers of postponing testing.  

• Radio spots on WJGK, Fox energy, WDLC and WALL regarding breast health in women and safety measure practiced in the Breast Center were presented by the Director Dr. Nathaniel Margolis and Surgeon Dr. Paramjeet Singh in October 2020. 
• A dedicated employee mammography screening day was held in the fall of 2020.  We welcomed a full schedule of employees that day, ensuring that we supported the women in our organization in getting their needed imaging

One effect of the pandemic has been that more women have been diagnosed with later stage breast cancers because of delays in testing.  Our goal continues to be to make every woman feel safe, protected and supported in visiting us for her breast imaging, knowing that we provide excellent clinical care with a warm and friendly staff.

Radiation Oncology treats cancer and non-cancer patients (thyroid) with radiation using different modalities.  High-energy radiation is administered using a linear accelerator or brachytherapy. Radiation therapy is given with a curative or palliative intent.  

2020 required many changes to our services and work flow due to the pandemic.  We instituted tele-visits, had to restrict visitors, and relieve anxiety of staff and patients.  Our goal was to ensure that patients felt cared for and supported during radiation treatment.  Despite the COVID crisis, we treated about the same number of patients in 2020 as previous years.  We are grateful to our staff, providers and our patients in making this possible.

The standard in radiation has been the practice to tattoo patients with a small dot to guide positioning. We are proud that in the midst of a worldwide pandemic we won an award from Vision RT (which is an optic surface monitoring system to help with patient set-ups) recognizing our center as being part of an exclusive but growing group of tattoo and mark-free centers around the world. 

In 2020 we moved forward with expansion of Stereotactic Body Radiotherapy (SBRT) for prostate cancer.  We also treat lung, spine, brain and pancreatic cancer with this modality. This state of the art treatment, reduces the number of treatments for prostate cancer from 45 to 5 with highly effective pinpoint accuracy.  We are proud that as a Comprehensive Community Cancer Center we are able to offer this advanced treatment close to home for our patients.  Our Urologists and Radiation Oncologists collaborate to plan and treat every patient with precision and safety and personalized techniques selected based on the needs of each patient.  These include the use of gel spacer to protect vital organs and fiducials markers that ensure precise targeting.

One exciting improvement in Radiation was the installation of a brand new Large Bore CT.  Features of this latest technology include radiation dose reduction software, accuracy to 0.6 millimeter in imaging slice thickness, and software to minimize interference from implants the patient may have, a larger field of view with a large bore, and the ability to perform 4D CT which allows us to track tumor and internal organ motion accurately.

As the old saying goes, it takes a village.  This year was a challenge of tremendous growth where we grew as a team holding steady to faith, hope, and each other.  As we look to 2021-2022, we look forward to seeing our patients/staff mask free and continue to serve our community.