Oncology Annual Report

Orange County completed a triennial Comprehensive Community Health Needs Assessment (CHNA) for 2014–2017 to evaluate the health needs of individuals living in Garnet Health Medical Center service areas. This plan was prepared with the collaboration of diverse stakeholders from the community. Its intent was to provide key health information and a framework to be used to advance strategic health planning in the county. Per Commission on Cancer Accreditation standards, our Patient Navigation Program based its areas of focus on the health care disparities and barriers to cancer care identified in the CHNA and the need to match patients with resources to address those barriers.

The CHNA identifies cancer as the second leading cause of death and lung cancer as the primary cause of cancer deaths for both males and females in Orange County, NYS and in the U.S.

Breast cancer is the most common cancer among women in the county (highest incidence rate) and the incidence of breast cancer death is higher than that of NYS as a whole. A number of overarching issues contribute to increased rates of cancer in the county including poverty rates that are as high as 59.5% in some areas, high rates of obesity and higher than state averages for smoking.

View Community Service Plans

Our Navigators served 800 patients with cancer or with breast health concerns (such as genetic risk of breast cancer and breast atypias) in 2016. The Navigators attend tumor boards and meet regularly with physicians and other credentialed providers (such as thoracic surgeons, breast surgeons, medical oncologists, radiation oncologists, nurse practitioners, hospice nurses, and palliative care providers) who provider referrals and identify potential issues. Garnet Health Medical Center has a weekly lung screening clinic. The Lung Navigator meets with all patients at the lung screening to assist with access to resources such as smoking cessation, or who have an identified finding needing follow-up.

Cancer Patients Navigated in 2016 -

• Breast Patient Navigator
  • Cancer:   199
  • Breast Health Concerns:   348
• Lung Patient Navigator:   189
• Head & Neck Patient Navigator:   64

Total: 800

Garnet Health Medical Center nurses work with cancer patients complete a distress screening upon admission to the inpatient cancer unit, or at the start of radiation or chemotherapy. This provides an important tool to help identify issues early in care. Barriers to care are also identified by the Navigators themselves and identified incidentally by other healthcare providers at Garnet Health Medical Center.

The Navigators also assist patients who need specialists or primary care.

Referrals Provided for Health Care System Identified Barriers

• Financial/Insurance Concerns:   104
• Community Referrals Financial:   412
• Education Books/Guides:   1854
• Distress/Coping/Psychological Support:   735
• Work Related Disability:   57
• Child or Elder Care Needs:   24
• Smoking Cessation:   149
• Nutritional Support:   187

Total: 3522

Referrals Provided for Additional Barriers

Physician Referrals - 

• Primary Care Physicians:   13
• Surgeons:   61
• 2nd Opinion:   69
• Medical Oncologist:   45
• Needs PCP:   56
• Dental:   89
• Hospice/Palliative Care:   113
• Plastic Surgery:   22
• Radiation Oncologists:   26
• Other:   48
• Disease Management
• Home Care/Outpatient Services:   131
• Complimentary Therapies:   27
• Oncology Specific Support Services:   159

Transportation Assistance - 

• Medicaid/ACS/Ride2Survive/Acts of Kindness:   443

Cultural Literacy - 

• Education in format patient understands:   83

Total: 1585

Community Outreach is an important aspect of the Navigation program. Garnet Health Medical Center partners with Orange County Cancer Services to provide free mammograms to uninsured women. In 2016, 310 women were screened through this program. Our Breast Patient Navigator assists any of these women who have findings in obtaining needed care – which can be challenging for this population.

Garnet Health Medical Center also offers a number of Navigator-facilitated cancer-related support groups, including:

• Breast Cancer Support Group - Find encouragement & support with Breast Cancer Support Groups offered through Garnet Health Medical Center’s Ray W. Moody MD Breast Center.
• Lung Cancer Support Group - The Lung Cancer Support Group is for patients and their friends and families whose lives have been affected by lung cancer. The support group setting will provide education, resources and bring together people who have a similar diagnosis to share experiences, concerns and fears as they battle lung cancer together.
• Multiple Myeloma Support Group - This support group is for patients and their friends and families whose lives have been affected by multiple myeloma. Registration is not necessary and there is no charge for attending.
• Oral, Head & Neck Cancer Support Group - The Oral, Head and Neck Cancer Support Group has been established to bring people together who have been diagnosed with head and neck cancer. The Support Group setting will provide a confidential forum for patients to share experiences, concerns and fears.

As well as the Risk-Reducers (BRCA Positive) Support Group. These groups met a total of 59 times in 2016 with 247 participants.

PARTICIPATING IN COMMUNITY EVENTS

The Garnet Health Medical Center Navigators also support or participate in a number of community events including:

• Cancer Survivors Day
• Making Strides Against Breast Cancer
• Remembrance Service
• Look Good, Feel Better Program with AACS
• Hudson Valley Fiesta Museum Village
• Orange County Cancer Services: Brazaar Art
• Relay for Life
• Dress in Blue Day
• Palliative Care Symposium

The Radiation Oncology Department at Garnet Health Medical Center is committed to clinical excellence, outstanding customer service, and compassionate care. We do this while focused on the latest technology that enhance clinical quality outcomes for our patients.

STEREOTACTIC RADIOSURGERY (SRS) FOR THE BRAIN

Moved from frame based to frameless. With frame based, the patient would go to the operating room and have a halo screwed onto the skull. This was then attached to the linear accelerator table which ensured no patient movement as we targeted radiation to the tumors in the brain. We are now able to do frameless radio surgery in which a patient comes directly to Radiation Oncology and a custom face mask is fabricated.  Motion management and synchronized imaging allows us to ensure treatment delivery is equivalent to frame based.

STEREOTACTIC BODY RADIATION THERAPY (SBRT)

In 2017, with the purchase of the Varian True Beam we are now able to offer another treatment modality to our community. Stereotactic Body Radiation Therapy (SBRT) is used to treat small tumors in the body that cannot be removed surgically or treated with conventional radiation therapy. Currently we are providing this form of therapy for the lung and spine. If a lung patient meets the pre-selection criteria he/she would first have a CT scan done with our latest gating software. The gating software provides a highly accurate representation of the patient’s breathing. This allows us to then formulate a plan based on patient specific tumor motion and deliver high doses of radiation directly to the tumor with less exposure to normal tissue with shorter treatment time. 

In the near future, we will be providing this enhanced modality for prostate, liver, and pancreas patients. SBRT for the prostate delivers very high doses of external radiation to the whole prostate gland while minimizing radiation exposure to adjacent normal tissue. Because SBRT delivers a much higher dose than conventional radiation therapy, the overall course is greatly reduced. Generally a full course of treatment for a prostate patient would be 8-9 weeks but with SBRT it is 1-2 weeks.

We look forward to the future as we continue to add modalities and the latest technology for Orange County and local communities.

The National Accreditation Program for Breast Cancer (NAPBC) project was part of the New York State Governor’s 2016 state initiatives. The goal is to increase breast cancer screening rates by 10% over the next five years. To accomplish this, a dedicated breast screening liaison has been added as part of our program to help identify patients and barriers in accordance to clinical guidelines.

Our liaison works with Federally Qualified Health Centers (FQHC) in gathering, coordinating and identifying issues while providing resources for patients at request. She works closely with the breast center team while providing further assistance and quality care.

The liaison works with patients to schedule appointments, coordinate prescriptions and referrals, provide resources to assist with uninsured and underinsured programs. She identifies barriers that make it hard for women to receive mammograms. This program assists in the early detection of breast cancer and strives to increase cancer screening access and awareness in our community.

The goal for this project is that each center reaches 800 eligible women per year.  We are proud to report that our bi-lingual liaison has reached over 1700 women in our first year, over 500 of whom completed their breast screening at either Garnet Health Medical Center or Garnet Health Medical Center - Catskills.

Clinical oncology trials at Garnet Health Medical Center 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. Clinical trials contribute to the overall knowledge and progress made in developing therapies for diseases, such as cancer. These research studies are conducted to determine if a study drug or delivery method is safe and effective. Patients who agree to participate may possibly benefit from the research study, while receiving the best current standard treatment as well.

Our team proudly participates in groundbreaking, high priority studies driving new treatment options with investigational medicine and treatment. Garnet Health Medical Center is able to provide the community with the highest level of care through clinical trials close to home. Garnet Health Medical Center was recently awarded main member status with the Southwest Oncology Group (SWOG), and through this partnership, we are able to access to most cooperative group trials supported by the National Cancer Institute. Seven percent of the total analytic oncology cases were enrolled to a clinical trial at Garnet Health Medical Center; this exceeds the national average of 3-5% of adult oncology clinical trial patients. Our efforts were recognized and awarded Commendation status by the American College of Surgeons Commission on Cancer (ACOS COC).

Each clinical trial is approved by the Garnet Health Medical Center Institutional Review Board (IRB), which reviews the research to protect our patients’ rights. This is a federally regulated board approved by the Office of Human Research Protection. In 2015 and 2016, the ORMC IRB met 12 times and approved 26 new protocols along with many annual renewals, revisions and amendments.

Each year at Garnet Health Medical Center, hundreds of oncology cases are screened for clinical trials. Eligible patients are giving the option to enroll through their oncologist. All of the local oncologists are investigators; Dr. Jeffrey Stewart is the principal investigator. He oversees all oncology research at Garnet Health Medical Center.