Upstate Medical University’s Upstate Cancer Center — Central New York’s only academic-affiliated cancer institution — is pursuing a long-term growth plan that matches requirements for National Cancer Institute cancer center designation. Its team has already begun programmatic expansion coordinated with its robust research, leading-edge technology and multidisciplinary model of care.
During the past year and a half, the five-story, 90,000-square-foot Upstate Cancer Center has undertaken a significant structural reorganization to enhance its areas of strength and its ability to offer patients the latest in cancer care, including personalized medicine. This effort included appointing its first Director — Interim Director and Chair of the Department of Radiation Oncology Jeffrey Bogart, MD — as well as associate directors for clinical research, operations, basic and translational research, and community outreach.
An exciting period of growth has coincided with the Cancer Center’s restructuring. The strength of Upstate is the ability to offer patients a team-based approach. The Cancer Center recently added a melanoma tumor board to a roster that already included focused programs for breast cancer, prostate cancer, hepatobiliary and pancreatic cancer, head and neck cancer, thoracic oncology, gynecologic oncology, neuro-oncology, stem cell/bone marrow transplant, and thyroid cancer.
“Our faculty team features more than 100 clinicians who focus on diagnosing and treating cancer,” Dr. Bogart says. “We take great pride in the expertise of our clinicians, many of whom are fellowship- and subspecialty-trained. Upstate is also fortunate to have several nationally and internationally known cancer researchers who have been key in designing major clinical trials conducted at oncology centers across the country.
“Our primary goal for the future of the Cancer Center is to continue strengthening our patient-first philosophy,” Dr. Bogart adds. “This starts with personalized and precision medicine, in which we’re already quite strong. We recently welcomed a new genetic counselor, and our clinicians will continue to work closely with pathologists and cancer researchers to create individualized therapies as appropriate. We also serve our patients by offering the greatest variety of cutting-edge technology in the region, so patients have a choice of options and can choose the treatment that best fits their needs.”
Collaboration, Convenience and Efficiency Intersect
Established in the 1990s, the Thoracic Oncology Program (TOP) is the Cancer Center’s longest established disease-specific program, and serves as the model for those that followed. TOP serves mostly lung cancer patients, as well as individuals with esophageal cancer and other thoracic malignancies. The TOP team includes pulmonologists, radiation oncologists, surgeons, a medical oncologist, a specialized chest pathologist, a specialized chest radiologist, a respiratory therapist, a nutritionist and a social worker.
“This is a tumor board in every sense of the term, but the difference is that all of the clinicians are present at the clinic when the patients are there,” says Jason Wallen, MD, MBA, FACS, FCCP, Assistant Professor of Surgery and Medical Director of the TOP at Upstate Cancer Center. “After everyone discusses a patient’s case, we can walk down the hall and meet with him individually. In a conventional tumor board, if a member wishes to meet with a patient to discuss a treatment idea no one had raised previously, he has to wait for the patient to return to the clinic. That is not the case in our model.”
The Upstate Cancer Center was the third center in the United States to offer Vero Stereotactic Body Radiotherapy. The Vero locates tumors and delivers direct radiation precisely where it is needed. Radiation oncologist Anna Shapiro, MD, explains it is one of a dozen highly advanced radiation therapy technologies offered by the Upstate Cancer Center.
Surgeon Ajay Jain, MD, confers with a patient following her treatment and surgery for pancreatic cancer. The care plan created by the Upstate Cancer Center team, which included measured chemotherapy and precision radiation followed by meticulous surgery, provided her with the best possible chance of remaining cancer free.
All patient navigators at the Upstate Cancer Center are nurses. Nurse navigator Ellen Scott, RN, (center) cares for patients with cancers of the head and neck and guides them from treatment to recovery.
During a typical first appointment at the TOP clinic, patients who are referred for a suspicious chest or lung abnormality undergo imaging exams in the morning and meet with members of the team in the afternoon. They spend several hours at the clinic, but by the time they leave, they have met with a surgeon, a radiation oncologist and a medical oncologist, as well as, potentially, a respiratory therapist to discuss smoking cessation, a nutritionist to learn how to improve health through diet and a social worker to discuss financial concerns. Patients who come to the TOP clinic with a cancer diagnosis may have shorter appointments, as the team can focus exclusively on devising a treatment plan.
“No clinician in our program makes decisions in a vacuum,” Dr. Wallen says. “Everyone gets what amounts to multiple second opinions on each patient. This is great for patients because they can make decisions about their care appropriately only if they understand all of their options. The other big advantage of this model is the speed of care. With lung cancer, we know outcomes are worse when treatment is initiated beyond eight weeks from the discovery of an abnormal lesion. In a private-practice model, after a patient goes through multiple clinicians to investigate a suspicious lesion, it might be one and a half months before treatment starts. In the TOP, we can compress diagnosis and treatment planning into a five-hour window. Our therapeutic options include many of the most advanced drugs available, as we offer more clinical trials for lung cancer patients than any other academic medical center in the state of New York.”
Several of the Cancer Center’s other programs follow the multidisciplinary trail that the TOP blazed.
“Our Breast Cancer Program has followed this model for quite some time, and our Head and Neck Program uses it, too,” Dr. Bogart says. “Many of our other programs have frequent multidisciplinary tumor boards that act as virtual clinics to ensure we see patients in a timely manner.”
Upstate Cancer Center is one of only four facilities in the United States to offer Vero Stereotactic Body Radiotherapy. This image-guided treatment uses real-time tumor tracking to allow clinicians to precisely irradiate malignancies even as they shift with patients’ respiration, all while sparing nearby structures. Vero is one of four stereotactic radiotherapy options at the Cancer Center; the others are Varian TrueBeam, TomoTherapy and Gamma Knife Perfexion.
More technological advances can be found in the Cancer Center’s intraoperative suite, which features an interconnected operating room (OR), MRI unit and additional procedure room. This suite has transformed the surgical process for neuro-oncology patients and could do the same for others.
“In conventional neurosurgery, the surgeon performs the procedure, closes the patient’s skull and orders an MRI to view the results. If imaging then reveals a part of the lesion the surgeon missed, he or she must perform a second procedure,” says Richard Kilburg, MBA, Associate Administrator for the Cancer Center. “In our intraoperative suite, during surgery, the surgeon can move the patient from the OR to the MRI, obtain the imaging study, and return to the OR to finish the procedure, thereby saving a surgical step. This is safer and more efficient for patients. We envision expanding the use of the intraoperative suite to other types of cancer surgeries in the future.”
Technology is also reshaping diagnostics at the Cancer Center. In men with suspected prostate cancer, clinicians recently began using the UroNav Fusion Biopsy System. UroNav marries MRIs taken before the biopsy with real-time ultrasound images during the procedure, allowing clinicians to more easily locate prostate tumors.
Shaping Cancer Care’s Future
Leszek Kotula, MD, PhD, Associate Professor of Urology and Biochemistry/Molecular Biology at Upstate Medical University, describes clinical trials as “the future of personalized medicine” for cancer patients. Last year, patients had the opportunity to participate in 156 clinical trials there.
“Our academic affiliation is critical to our ability to lead and participate in these investigations,” Dr. Kotula says. “Nonacademic cancer centers cannot do research on the same level that centers with academic backing such as ours can.”
Leszek Kotula, MD, PhD
The Thoracic Oncology team was the first multidisciplinary cancer team at Upstate. This approach allows a patient, in one appointment, to meet with specialists from Thoracic Surgery, Medical Oncology, Radiation Oncology, Pulmonary Medicine, Thoracic Radiology and Cytopathology. The team also meets together to review cases to provide the greatest number of treatment options to patients.
Earlier this year, leaders identified the following four areas of investigative focus, based on the Cancer Center’s strengths:
- Developmental cancer therapeutics and drug design — Work in this area includes developing ways to target p53 gene mutations, which are implicated in many cancers, as well as developing nanoparticles to deliver drugs to tumor sites.
- Hematologic malignancies — Researchers focus on understanding the mechanistic underpinnings of blood cancers, developing new therapeutics, and identifying new targets and biomarkers for drugs.
- Translational Program in Urological Cancers — Co-led by Dr. Kotula, this program uses a variety of multidisciplinary methods, including biochemistry, cell biology, structural biology, mouse models, bioinformatics and genetics, to better understand progression, tumor suppression, and drug resistance in prostate and kidney cancers.
- Tumor microenvironment and invasion — Researchers seek to define the molecular and cellular changes that pave the way for tumors to spread beyond their local environments.
“Forming these four programs allows us to pursue new avenues of investigation using new collaborations,” Dr. Kotula says. “Most importantly, it broadens the scope of what’s available to patients.”
For more information, visit upstate.edu/cancer.