Oncology Annual Report

In the Spagnoli Family Cancer Center at Garnet Health Medical Center we are fortunate to have a dedicated team of Oncology Nurses on our Inpatient Oncology Unit, Eleanor Snow Radiation Oncology Center and in Infusion. We are proud that our percentage of Oncology Certified Nurses (OCN) exceeds national averages for cancer programs.  This credential, overseen by the Oncology Nursing Society (ONS), demonstrates that nurses have the knowledge, skills, and attitudes to provide high quality care to cancer patients and their families. In 2021, we continued to provide support to all eligible nurses in obtaining their OCN by providing review courses and materials and by participating in the ONS free test take program. 

In 2021, infusion worked on a quality improvement project with Pharmacy to optimize the workflow of medication preparation for Infusion treatments.  This optimization is important to ensure the timeliness of treatment and to safeguard patient safety by ensuring that nurses and pharmacists have the needed time to check and double check all medications and treatment plans, while being able to listen carefully to our patients. These improvements resulted in an overall average reduction in patient wait times of 15 minutes - even with large increases in patient volume.

The pandemic greatly affected cancer screening rates.  Because in person events were discouraged due to safety concerns, community screening events didn’t occur.  People were also reluctant to visit doctors and hospitals unless absolutely necessary, so many missed regular screenings they normally would have completed.  

To reverse this reduction in cancer screening which would result in more cancer deaths if not addressed, the Commission on Cancer (CoC), the American Cancer Society (ACS) and the National Accreditation Programs for Breast Centers (NAPBC) collaborated to create a Plan-Do-Study-Act (PDSA) quality improvement project and clinical study to accelerate the return of the public to cancer screening. The goal was for study participants to return to pre-pandemic rates of screening. 

Garnet Health enrolled in two return to screening studies:  one focused on Breast Screening and one on Lung Screening.
Lung Screening is designed to increase early detection of lung cancer for people who are at elevated risk for the disease. It is annual screening with a low dose CT for those who meet the following criteria:

• Between 50 and 80 years of age
• Have smoked within the last 15 years
• Have smoked 20 pack years or more (the equivalent of 1 pack per day for 20 years)

For the Lung screening study, Garnet Health implemented several interventions to improve lung screening rates.  These included increasing the number of appointments available for Lung Screening, call backs to any patients who were “no-shows” for Lung Screening appointments, a Public Service Announcement from Dr. Cleveland Lewis, Thoracic Surgeon, posted on social media in June, a Men’s Health Webinar on cancer screenings in September, and a Great American Smoke Out/Shine a Light on Lung Cancer educational event in November.

Garnet Health ‘s lung screening rates not only returned to pre-pandemic levels, there was an overall 7% increase in screening over target.
For the Breast Screening PDSA, the study focused on the rates of screening mammography.  The interventions undertaken to increase these numbers included patient reminder phone calls, 2 in-person screening events in June and October, 28 social media posts, and breast education and outreach at Farmers Markets and community events such as Making Strides Against Breast Cancer.

Progress was slow at the beginning of the study, with the first 3 months below pre-pandemic rates, but by the end of the study, the number of screening mammograms performed was 10% above target.

These studies demonstrate an additional benefit of national accreditation, the ability to participate in collaborative studies and to access national data in making improvements to our cancer program.
 

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 2021, the pandemic continued to hamper 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.  

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
  • This event raises funds to provide grants to cancer patients. A unique fundraiser was done this year- Valentine’s Day candygrams.  Employees and volunteers could send candygrams  throughout the organization. Not only was this an incredibly successful fundraiser for a great cause, it provided a fun spirit boost for our hard-working staff! 
• Lung Force Walk
  • Garnet Health participated in Lung Force in June at Manhattanville College. This event raises funds for lung diseases and lung cancer.
• HPV education was provided to Garnet Health Doctors clinicians. 
• Making Strides Against Breast Cancer
  • Garnet Health was recognized by the American Cancer Society for 25 years of participation in Making Strides of the Hudson Valley.  Once again, we were Flagship Sponsors of this event on October 17, 2021 at Woodbury Commons. We proudly raised over $40,000 for this great cause!

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. Once again, we 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 2021.  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 reached-out to 3,625 women in 2021 to encourage them to complete their breast screening.
• We implemented Elucent wire-free localizations in the Breast Center this year. With this device as well as the Savi Scout wire-free localization device, we have eliminated the need for day of surgery wire localizations except in very exceptional circumstances.  This change makes the process of breast surgery much easier for our patients.
• Patient Satisfaction with the Ray W. Moody, MD Breast Center was above the 90th percentile nationally on Press Ganey, our patient survey
• Garnet Health partnered with the restructured Hudson Valley Cancer Services Program.  This state-funded initiative supports breast imaging for uninsured and underinsured patients in Orange and Sullivan Counties.

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

• Breast Center Staff did educational outreach at Farmer’s Markets, a “Pink-Out” Event held by the American Cancer Society, and Making Strides Against Breast Cancer. 
• Two dedicated employee mammography screening days were held in 2021.  We welcomed a full schedule of employees both days, 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.  

2021 was a year of growth and change in Radiation.  Accomplishments this year include:

• Upgrading our electronic medical record for Radiation to Aria version 16. This upgrade includes enhancements to our comprehensive array of radiation treatments.
• The Upgrade also included Insightive which is system for Radiation Oncology reporting 
• Radiation received ACR re-accreditation  
• Gabapentin has been shown to be very effective in pain control for Head and Neck Cancer patients.  Radiation began a study of its effectiveness for these patients at Garnet Health. 

In 2021 we continued to move 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.

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.