Access to Care
Fellowship
Research
Conferences
Policies and Procedures

The overall goals of the Section of Oncology are the delivery of outstanding cancer care, oncology teaching, and clinical research.  The long-term goals are to develop and refine the most advanced cancer treatment and management services for the changing health care environment.

Key events for 2005 include:
· The continued development of programs of excellence
· Delivery of 24/7 service in the ambulatory comprehensive cancer center
· Management of a superb fellowship program in hematology oncology
· The further development of the clinical research program
· Enhancement of case based interdisciplinary management conference
· The refinement and development of infrastructure and policy and procedures
· New recruitment to the Division of Medical Oncology

24/7 Access to Care
During the last year we have continued to refine the model of increased access to care for outpatients in a 24- hour-a-day, 7-day-a-week environment.  The known benefits of such a shift include more efficient utilization of institutional resources and a better quality of life for patients and their families. Medical advances, including antiemetics, intravenous access, pain control, antibiotics, and more effective treatment, all contributes to the feasibility of ambulatory treatment.  Our 24/7 ambulatory facility became operational in February 1997, but we have continued to expand the services to include stem cell apheresis, ambulatory supportive care for patients undergoing transplant and intensive chemotherapy for myeloma.

As a standard of practice in ambulatory care, we continue to provide patients with more prolonged assessments and interventions including transfusions and hydration, chemotherapy treatments, and pain management.  Increased access to care, particularly after working hours, improves convenience for patients and families. The 24/7 access also results in decreased utilization of the Emergency Department, greatly increasing patient satisfaction, safety, and outcome.  In addition, the 24/7 access has significantly reduced inpatient utilization.

Over the last year, we have continued to develop integrated care.  Our patient centered care includes the services of nursing, pharmacy, pain assessment intervention, nutrition counseling and social work. Holistic assessment, which works integratively with nutrition counseling, and financial counseling are also offered. The 24/7care system was moved to our new 70,000 square foot, Comprehensive Cancer Center on 15th Street in August 1999.  In 2004, a GE PET CT scanner was made operational and has markedly enhanced our diagnostic capabilities. Because of increased patient volume, our cancer center is negotiating the acquisition of an additional 40,000 square foot of space for clinical program expansion and the addition of another MRI scanner. 

Fellowship Program
Our fellowship program continues to be the main focus of our professional teaching.  The fellowship rotation has been restructured in response to the development of Saint Vincent's Comprehensive Cancer Center, and the Section of Oncology in the Department of Medicine.  The driving force in the restructuring is the increased emphasis on ambulatory care.  To this end, the fellow's outpatient clinical assignment is four months a year.  During that time, he or she does consultations on new patients and  follow-up on outpatients five sessions a  week under the supervision of an attending physician. The inpatient experience is now four months a year with responsibility for the Cancer Center Unit (Coleman 16), as well as inpatient consultations - both for Hematology and Oncology.  For the remainder of the four months, two months are used for electives including Coagulation, Blood Banking, and Radiation Oncology.  During the other assigned months the residents maintain a continuity of care clinic three sessions per week.

The ambulatory experience has been revised to take into consideration a number of issues.  First,  the increasing shift to and emphasis upon ambulatory care for people with cancer and hematologic disorders, and second, the integration of what had been the fellows "clinic" into the Cancer Center as a whole, offering the same experience for all patients, independent of their insurance status.  The restructuring also provides the opportunity for one-on-one attending-fellow partnering and the enhanced opportunity to provide continuity of care. 

We have also obtained approval from the Medical Residency Review Committee (RRC) to offer a fourth fellowship position.  The fourth fellow began his Hematology/Oncology fellowship on 7/1/01.  Two fellows that joined the program on 7/1/04 are Meghana Bhandari, M.D. and Reshma Mahtani, D.O., who completed their medical residencies of St. Vincent's in June 2004. Dr.  Gerry Capo, who completed his fellowship in June, 2005, has been accepted into the Palliative Care Fellowship Program at Memorial Sloan Kettering. Dr. Kevin Sullivan, who trained in Internal Medicine at St Vincent's, joined our fellowship program on July 1, 2005.

Research 
The developing research program contributes to the delivery of outstanding care by providing access to the leading treatment alternatives and advances in oncology.  Our Clinical Trials Office was established with an institutional commitment for a Research Coordinator, Research Nurse, Data Manager, and an Administrator.  Faculty or trainees in the cancer center initiate patient-oriented research through the Cooperative Oncology Group Program affiliation at NYU, or through the newly organized Aptium Oncology Research Department. Ms. Lori Megherian is the Administrative Director of Research, with five research associates currently supporting the program. Accrual to the research clinical trials continues to increase. Dr Sanford Kempin is doing an excellent job as Research Director and has recently been named Principal Investigator for a National Lymphoma Clinical Trial mounted by the ECOG.

Conferences 
The section has an array of case-based interdisciplinary medical conferences.  Dr. Michael Sarg, Associate Chief of the Section, leads Journal Club Conferences once a month. These sessions incorporate critical reading and evaluation of current literature. This forum promotes staff awareness and knowledge of new developments in the field of hematology and oncology. Interested staff from sections of the Department of Medicine and other departments are invited to attend the Journal Club Conferences.

Tumor Board Conferences are held each week.  The educational objective for these conference is to provide appropriate case management of several unique cases.  The sessions include valuable interdisciplinary discussion and review of patient x-rays and pathology with the staff from Radiation Oncology and the Department of Surgery and Pathology.

Disease site-specific conferences are all interdisciplinary, case based, and prospective in nature.  Hematopathology conferences are held once a month; these conferences promote the development of knowledge in hematopathology and familiarity with new stains and markers. Neuro-oncology conferences are held once a month to promote the development of knowledge in the area of neurology and oncology. These meetings are held in conjunction with the Department of Neurology, Neuro-Surgery, and Pathology. Thoracic Oncology conferences are held once a month to promote the development of knowledge in thoracic oncology.  This meeting includes Pulmonary Medicine and Thoracic Surgery. Head and Neck conferences are also held once a month in conjunction with the Departments of Radiation Oncology and Otolaryngology.

Hematology-Oncology Grand Rounds are held monthly.  This series is delivered by leading national figures in hematology and oncology with emphasis on research based presentations.  New patient clinical conferences are held every Thursday morning.  All new patients seen in the previous week are discussed with interdisciplinary input with emphasis on natural history, diagnosis and management, including consideration of research protocol eligibility.

As part of a broader teaching program and in an effort to increase communication, a Patient Management Conference has been established to integrate patient care, stimulate interdisciplinary interaction and  communication and set standards of care.  The attendees include physicians, nurses, research team members, psychosocial teammembers, pharmacists, and financial counselors. The case based discussion focuses on preselected patients identified as prototype management problems and patients added during the time of the conference.  A new patient conference, which includes attending physicians and fellows, reviews in a more didactic way the interdisciplinary discussion of the management and workups of new patients.

Policies and Procedures
As this is a developing program, significant time and effort has been placed in the hiring of staff, the development of policy and procedures and infrastructure development.  We have also partnered with other programs within St. Vincent's Comprehensive Cancer Center to achieve a seamless and cohesive cancer care delivery system.