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Peeples Cancer Institute Treating Patients, Providing Hope

April 12, 2020

Peeples Cancer InstituteWhen guests enter Peeples Cancer Institute (PCI), they are welcomed by a greeter who is equipped to answer questions and escort them where needed. The institute has a spacious lobby that was specifically designed to provide a calm, relaxing atmosphere.

“First impressions are important and our intent is to clearly convey confidence, tranquility, and healing,” says Ernie Elemento, vice president.

The 46,000-square-foot facility opened in January. Accredited by the Commission on Cancer (CoC), the institute centralizes patient-centered care and outpatient cancer services in one convenient location.
Patient experience is a significant focus of the institute.

“Every aspect of Peeples Cancer Institute is focused on the needs of our patients and families so that we provide an outstanding patient experience and the best clinical outcomes,” says Jeff Myers, president, and CEO of Hamilton Health Care System. “Our goal is to foster collaboration, communication and education among physicians and our medical teams to advance and enhance our care for patients. They are our number one priority.”

Expert Care
Eric Turner, MD (medical director) and Qin Zhang, MD, recently joined PCI. Both are board-certified medical oncologists and specialize in adult cancer and hematology disorders. They join Lisa Duhaime, MD, and Freda Hoffman, APRN, on the medical oncology side. Arif Ali, MD, and Nick Galanopoulus, MD, are both board-certified and provide radiation oncology treatment and services.

Surgeons from Hamilton Physician Group – General Surgery all participate in cancer-related surgeries. Surgeons include Richard Fromm, MD; James Gable, MD; Eric Manahan, MD; Steven Paynter, MD; and Rod Rodriguez, MD. Fromm, Manahan, Paynter and Rodriguez are breast cancer specialists.

Other members of the clinical care team include radiologists, pharmacists, clinic nurses, infusion nurses, nurse navigators, radiation therapists, mammography technologists, social workers, researchers, tumor registrars, and other vital staff members.


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Under one roof
The goal of integrating all outpatient cancer care services under one roof was the driving force behind the expansion of the oncology program into its newly constructed building. The process was conducted with the needs of the patient, community, and staff in mind.

As the planning process for the new cancer institute began, Hamilton’s leadership and staff engaged the community to provide feedback throughout every step of its design. For example, the initial design did not include a physical connection to the main hospital. After hearing the concerns of the focus group, Hamilton’s leadership worked with the city council to close a public road and allow the construction of a walkway physically connecting the new cancer institute to the main hospital.

PCI centralizes all oncology care in one location, further enhancing physician collaboration and quality patient care. With Hamilton Medical Center connected directly to the institute, in-patient care is enhanced by ease of patient transport.

The community feedback is also reflected in the interior design of the new facility. Patients and caregivers, including those who received cancer care elsewhere, provided their input.

“We heard them loud and clear,” says Elemento. “They did not want to sit in an infusion chair for hours receiving chemotherapy while staring at a wall.” Today, patients receiving treatment in one of the 20 semi-private infusion recliners have expansive views of Dalton through floor-to-ceiling windows that provide abundant natural light. Six additional chairs are private, allowing patients privacy if they prefer.

The latest technology
Equipped with a state-of-the-art Varian™ Truebeam™ Linac and 4D CT simulator, the cancer institute offers a variety of radiation therapy treatment modalities, including IMRT, SRS, SBRT, 3D and HDR brachytherapy.

The Women’s Imaging area offers the latest in 3D mammography, stereotactic biopsy and ultrasound.
Looking to the future, the institute is already looking to expand its capabilities.

Looking ahead
The institute continues to work on opportunities to provide additional treatments and ways to support patients and family members.

The pharmacy is working toward an accredited specialty pharmacy that would include oral oncolytics, specialty drugs that kill cancer cells.

PCI will soon offer patients access to participate in clinical trials. The PCI employs a research coordinator to enroll patients into clinical trials when appropriate, and the institute’s medical oncologists will provide oversight as principle investigators for all trial patients.

As part of the high-risk genetics program, patients will be followed in a high-risk genetics clinic at PCI and receive additional needed services such as annual breast MRI screening or other imaging and testing when appropriate.

The institute will soon offer genetic screening and genetic counseling services. Patients identified as high-risk are given immediate access to a certified genetic counselor through tele-genetics. The new facility is completely wired and ready for telehealth, and its tele-genetics program is the first step in utilizing these new features.

PCI has been working on increasing its menu of supportive care programs for patients.

Growing these services allows the program to support patients emotionally, mentally, and physically throughout their cancer treatment journey.Rita Harris, oncology service line administrator

A donor’s gift is making it possible for the institute to begin planning an arts and healing program that will bring music and art to its patients and caregivers. A therapy dog visits the infusion center weekly, and the Institute is developing a pet therapy program that will allow therapy dogs to visit with patients throughout the facility, thanks to a gift from Dalton Box. The institute will soon welcome a specialized oncology nutritionist to provide nutrition and wellness counseling and services. All supportive care services at PCI are offered free as part of a cohesive cancer-fighting strategy for patients, from prevention and diagnosis to treatment and survivorship.

Filed Under: Community, Excellence at Hamilton, Hamilton Cancer Updates, Health & Wellness, News Tagged With: Arif Ali, breast cancer specialists, cancer, Commission on Cancer, Eric Manahan, Eric Turner, Freda Hoffman, genetics program, Lisa Duhaime, mammography, manahan, MD; and Rod Rodriguez, MD; Steven Paynter, MD. Fromm, Nick Galanopoulus, Paynter and Rodriguez, Peeples Cancer Institute, Qin Zhang, Varian™ Truebeam™ Linac and 4D CT simulator

Hamilton Surgeon Chairs National Panel Changing Breast Cancer Genetic Testing Guidelines

March 7, 2019
Eric R. Manahan, MD
Eric R. Manahan, MD

The American Society of Breast Surgeons released new consensus guidelines on Feb. 14, calling for genetic testing to be made available to all patients diagnosed with breast cancer. The new guidelines expand earlier recommendations that encouraged testing only for certain age groups and types of cancer.

Eric R. Manahan, MD, a surgeon at Hamilton Physician Group – General Surgery in Dalton, chaired a group of world-renowned genetics experts to draft this new consensus statement. Other represented institutions included Johns Hopkins, Memorial Sloan Kettering (New York City), MD Anderson, Mayo Clinic and Harvard Medical School, to name a few. The statement is based on an extensive review of current literature that suggests that recent National Comprehensive Cancer Network (NCCN) criteria resulted in a number of potential disease-producing variants going undetected. Some patients and their family members developed cancers that could have been prevented with testing under the new, broader guidelines.

Identification of specific genetic inconsistencies in breast cancer patients often provides crucial guidance for more effective disease management.  Additionally, relatives of those who are shown to have abnormalities and have a high probability of carrying the same potential disease-producing genes also could be tested. This would offer appropriate risk-reducing strategies for early stage diagnosis. Currently, NCCN guidelines allow for testing of family members of patients with identified potential disease-producing variants but only identify about 50 percent of breast cancer patients with those variants.

“Cancer risk assessment is an important part of well care for all of us,” said Manahan. “We look to activities or lifestyle changes including dietary habits that we can change to reduce our risk for certain types of cancer. We have also learned that more than 10 percent of all cancers do have some genetic component that can increase our risk for developing certain cancers.”

Breast cancer in the United States was estimated to affect more than 266,000 people in 2018. Of that number, approximately 40,000 would be expected to die from their disease. While experts have been looking at the genetic information of women with obvious family history of breast cancer, recent data has shown that genetic information may also be valuable and impact future care decisions for many other women where there is not a family pattern.

 

Frequently Asked Questions

Should I have genetic counseling?

The choice to have genetic counseling and proceed with genetic testing is one to be taken seriously and with some caution. Though it can sound simple to be tested, there are many things to consider before making this decision. Our physicians and nurses will help guide you through the entire process so you understand the pros and cons of genetic testing. If you or your family is interested, you should be certain to also ask for genetic counseling who can explain to you the meaning of the tests. Just because you may have a gene implicated in a specific cancer does not mean that you will definitely get cancer.

How do I initiate the process of testing?

If you have a significant family history of breast and/or ovarian cancer and you’re interested in genetic testing, it is recommended that a relative who has had breast or ovarian cancer be tested first. If your family member with cancer is tested and found to have an abnormality in one of these genes, other relatives with or without cancer may be tested for that specific genetic mutation.

If you then test negative for the genetic mutation that is known to be present in the family, your chance of developing breast or ovarian cancer is probably no higher than the risk faced by an individual without a significant family history. If you test positive, your risk for developing breast or ovarian cancer is substantially increased, but still not 100 percent.

What are the risks of genetic testing?

There are certain risks associated with genetic testing for cancer susceptibility, including the possibility of insurance or employment discrimination. There are some federal and state laws designed to lower the risk of insurance discrimination, but they only pertain to specific types of insurance. Other risks of genetic testing are adverse psychological reactions and disrupted family relationships. An individual who tests positive may experience anxiety, guilt, depression or fear. Family members may have similar feelings, which could cause strain between relatives.

What if I don’t have a family history of breast cancer? Should I be tested anyway?

The guidelines regarding who should be tested continue to evolve as we learn more about genetics and their role in cancer. If you have a question, ask your primary care physician.

Individuals who might consider genetic testing include:

  • All patients diagnosed with breast cancer and/or ovarian cancer.
  • An individual with a relative who has a pathogenic variant in a cancer susceptibility gene.
  • An individual who has a 1st or 2nd degree relative with any of the following:
    • Breast Cancer ≤ 45 y/o
    • Ovarian Cancer
    • Male Breast Cancer
    • Pancreatic Cancer
    • ≥2 Breast cancer primaries in a single individual
    • ≥2 individuals with breast cancer primaries on the same side of family with at least one diagnose ≤50 y/o
  • An individual with a personal and/or family history on the same side of the family of 3 or more of the following (especially if diagnosed age ≤50 y/o; can include multiple primary cancer in same individual)
    • Breast cancer, sarcoma, adrenocortical carcinoma, brain tumor, leukemia
    • Colon cancer, endometrial cancer, thyroid cancer, kidney cancer, dermatologic manifestations, macrocephaly, or hamartomatous polyps of GI tract.
    • Lobular breast cancer, diffuse gastric cancer
    • Breast cancer, GI cancer or hamartomatous polyps, ovarian sex chord tumors, pancreatic cancer, testicular sertoli cell tumors or childhood skin pigmentation.

What does genetic testing cost?

Genetic testing pricing has decreased significantly with multigene panel testing costing as little as $250. Many insurance companies cover the cost of genetic testing, though most companies require that the family history meet specific requirements. It is always best to understand your own insurance coverage before beginning the process of genetic testing.

Filed Under: Excellence at Hamilton, Hamilton Cancer Updates, Health & Wellness, News Tagged With: breast cancer, cancer, genetic testing, manahan, prevention

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