A ‘university’ approach to care
New JMC ‘clinic’ puts team of specialists on their patients’ case.
At age 87, Mary Dailey is not your typical breast cancer patient.
Good thing, then, that the approach Jupiter Medical Center took to her treatment was anything but ordinary.
Last month, JMC unveiled its new multidisciplinary breast cancer “clinic” — a collaborative protocol that brings seven specialists to a recently diagnosed patient.
That’s seven doctors with one appointment within a two-hour window, all under the same roof.
“I was very impressed with how well-organized and prepared they all were,” says Dailey, a vibrant grandmother of nine, of that initial appointment in early October. “They immediately put my mind at ease.”
Oncology surgeon Dr. L. Raul Arroyo, medical director of JMC’s Comprehensive Breast Care Program, has overseen the development of the system.
“It’s a university model,” Arroyo explains. “On the morning of a patient’s appointment, all of the specialists will first meet in a single conference room. We’ll discuss the patient’s condition and formulate a tailored treatment plan.”
Having all of specialists in the same room ensures that everyone is on the same page — and any potential issues can be resolved in real time. Attending that planning meeting are the following: ■ Oncology surgeon ■ Reconstructive plastic surgeon ■ Medical oncologist ■ Radiation oncologist ■ Physical therapist ■ Nutritionist ■ Medical researcher
The plan is then presented to the patient — who is being guided through the process by her patient navigator. After the plan is presented, and various options explained, the patient then meets with each team member.
“I got to spend time all the time I needed with each doctor,” says Dailey. “There was no rushing, they answered all my questions and everything was explained to me in detail. My son accompanied me that day — and he told me he was astonished at the efficiency.”
Arroyo believes that JMC’s new protocol “makes patients feel empowered and eager to start their treatment.” Dailey certainly was. Because the Jupiter octogenarian’s early-stage tumor — which was detected by JMC breast-imaging specialist Dr. Orna Hadar — was small, she was an excellent candidate for electron beam intraoperative radiation therapy (e-IORT).
The relatively new procedure — which is available at a only handful of hospitals throughout the U.S. — combines a lumpectomy with a brief, highly concentrated dose of targeted radiation, all while the patient is on the operating table.
Arroyo, who performed Dailey’s lumpectomy, says that undergoing e-IORT spared Dailey from the standard six to seven weeks of preventive post-surgical radiation that breast-cancer patients traditionally receive.
Currently, e-IORT is used to treat only breast cancer. Eventually, however, doctors foresee utilizing it on cancers such as uterine, ovarian, colorectal, lung and gastrointestinal.
Dailey had her outpatient procedure done Oct. 7 and says, “I was never in any pain afterwards. Just some tenderness — but I didn’t even need an aspirin.”
Considering how smoothly everything transpired, it
Hair loss is one of the most obvious side effects of cancer treatment. Now, a growing number of breast cancer patients are freezing their scalps as a way to preserve their hair during chemotherapy.
The hair-saving treatment requires a specialized frozen cap worn tightly on the head before, during and for a couple hours after a chemotherapy session. The method can be time consuming, expensive and uncomfortable, but numerous women swear by the results.
“I had the wig ready, but I never had to use it,” said Eileen Bruno, 50, of Westwood, N. J., who last year completed chemotherapy and cold cap treatment while maintaining her full head of thick, blond hair.
After learning that she had early-stage breast cancer, Bruno said she worried about her health — and losing her hair.
“Knowing I was going to lose my hair was an awful thing for me,” Bruno said. “I was really struggling with the fact that not only was I sick, but I was going to have to look sick to myself and the rest of the world.”
Bruno learned of the cold-cap treatment through friends, and gained the support of her doctors at the Weill Cornell Breast Center in New York, one of only a few New York hospitals that accommodate cold-cap treatment. The hospital has made space for a special medical freezer that keeps the caps ready at the right temperature, donated by the Minneapolis nonprofit group The Rapunzel Project.
Bruno used the Penguin Cold Cap, which is essentially an ice pack fitted tightly on the head like a swim cap. The cold caps, which are rented for about $600 a month for a set of caps, must be kept frozen and changed quickly every half-hour. Some patients hire “cappers” to help, paying $300 to $750 a day for the service.
Another scalp cooling system, called the DigniCap, is less labor intensive. It uses a small machine and tubes filled with a coolant to chill the cap.
Dr. Hope Rugo, the director of breast oncology at University of California, San Francisco, said the DigniCap may soon become the first scalp-cooling device to be approved by the Food and Drug Administration, a move that would increase the likelihood of insurance reimbursement.