Under One Roof – Local Projects Reflect the Evolution of Cancer Centers

In fact, as senior vice president of strategy and marketing for the Sisters of Providence Health System, it’s part of his job to understand the demographic and medical trends in the region — and how SPHS should respond to them.”

“Every year, we do a community health-needs assessment and some ongoing tracking of what’s happening with demographics and what’s happening with diseases in the region,” he said. “And cancer rates in our region are higher than the national trend. Meanwhile, our demographics are older than a lot of regions, and we’re aging in place; there’s not as much outmigration as in some other regions. And as folks age, we’ll continue to see both actual and predicted growth in cancer prevalence.”

In short, “we said, ‘wow, we’ve got some things we need to prepare for.’”

SPHS is doing so with a major expansion of its Sr. Caritas Cancer Center in Springfield, increasing its floor space from 16,000 square feet to almost 40,000 and bringing more cancer services together in one location.

“We’re bringing radiation oncology and medical oncology under one roof, which is ideal for the patient, both from a convenience standpoint and from a comprehensive care standpoint, because they can get all their care in one place,” Fulco said. And having everyone together in one place is very effective for clinicians because there is quite a bit of interaction between various medical specialists who provide care in the cancer center. So having everything together in one place is very efficient for both caregivers and providers.”

That under-one-roof philosophy is one that has guided the recent surge in dedicated cancer centers around the country and particularly in Western Mass., where Baystate Health’s 65,000-square-foot D’Amour Center for Cancer Care and SPHS’s Sr. Caritas Cancer Center, both built in 2003, pioneered the concept.

In addition to the Caritas expansion, Berkshire Health Systems, which runs Berkshire Medical Center in Pittsfield, opened the BMC Cancer Center last fall and is gradually moving all cancer services under one roof. Meanwhile, Cooley Dickinson Hospital in Northampton, which has collaborated with Massachusetts General Hospital on cancer services since 2009, is now affiliated with that institution and will open the Mass General Cancer Center at Cooley Dickinson Hospital next year.

“Cancer care is a multi-disciplinary disease,” said Dr. Sean Mullally, medical director of the CDH Cancer Care Program. “It requires the input of a medical oncologist, radiation oncologist, and surgical oncologist, and it’s very important, in many situations, to have a collaborative approach from all three specialties.”

Michael Leary, director of media relations at Berkshire Medical Center, said the way cancer patients were shuttled around just a few years ago is not considered acceptable today.

“Take a step back to what cancer services were like. You may have seen the hematologist/oncologist separately, and if you needed radiation services, you saw the radiation oncologist in a different location. If you needed rehabilitation therapy, you ended up in a third location. For social work, psychology, or counseling assistance of any kind, it was yet another location.”

That’s why the health system repurposed the original Hillcrest Hospital in Pittsfield to bring those services under one roof, said Ann McDonald, director of Oncology Services for BMC.

 “We opened initially with medical oncology, infusion, and laboratory services,” she told HCN. “Over the course of the next year, we will continue to add services, start opening some integrative health services, combining nutrition services, care navigation, social work, and movement therapy.

“The next phase, which won’t open until late this year, is a multi-disciplinary clinic, where patients can see a variety of physicians during treatment,” she continued. “We’ll have palliative-care services in the future. The last phase will be a year from now, when radiation oncology moves from its current site [at BMC] to the new cancer center. Then all our oncology physicians will see patients in one place.”

In this issue, HCN examines the recent evolution of cancer care at area hospitals and why both patients and providers are cheering the effort to bring comprehensive oncology services under one roof.

The plans for the Caritas Center expansion, which broke ground in the spring, include medical-oncology offices, including physician offices and examination rooms, on the first floor, and medical-oncology treatment space, including 32 infusion bays, an oncology pharmacy, and laboratory space, on the second floor. The project is expected to take 18 months.

The center is also adding two medical oncologists by the fall bringing that number to five, and has been using space in Weldon Rehabilitation Hospital — which, like the cancer center, is located on the Mercy Medical Center campus — pending the expansion of the Caritas Center.

Bringing more services into one building will offer patients much more efficient, comprehensive treatment, Fulco said. “By having the team together, we’re able to more efficiently deliver those services.”

 Another driving factor in oncology, reflected in the design of the expanded cancer center, is the shift from inpatient to outpatient care. “We’re preparing for that; we think more and more care will be delivered on an outpatient basis. Even today, most of it is, except for surgical treatment,” he noted. “Over the years, we’ve seen care and treatment dramatically change, both the way care is delivered and the setting.”

Meanwhile, the first phase of the new BMC Cancer Center opened in November, including the new offices of Berkshire Hematology Oncology, BMC Infusion Services, and the Cancer Center Laboratory and Pharmacy.

When the center is fully complete, it will include those departments in addition to radiation oncology — which is currently located at the main BMC campus — and integrative support services for patients and family. The idea, Leary said, was to for individualized planning and treatment care to be provided by medical, surgical, and radiation oncologists working as a team.

“The goal was to take all the disciplines and put them together in one location, which happens to be a very beautiful location, the Hillcrest campus of Berkshire Medical Center, formerly Hillcrest Hospital,” he explained. “It’s a really pretty section of Pittsfield, overlooking a gorgeous lake, surrounded by pine trees and walking trails. We wanted a location for patients that was calming and soothing, but also one place they could go to receive as much care as possible. They’re facing enough challenges as it is; we’re making it as easy as possible on them.”

That’s especially true in the Berkshires, he said, which is even farther from cutting-edge oncology services in Boston — or even major highways — than the other regional hospitals building or expanding cancer centers.

“It’s really important to provide this care close to home,” Leary noted. “In any small community, the tendency is to think you can’t get state-of-the-art, advanced care unless you go to Boston or New York — Sloan Kettering or somewhere like that.

“But with the investments Berkshire Health Systems has made in its cancer program over the past several years, we have technology that, frankly, many cancer centers don’t, including one of the highest-end versions of tomotherapy,” he said, referring to a form of radiation therapy. “We do that because we don’t want people to have to go to Boston or New York. Obviously, we’d rather they stay in their community for their quality of life — and it makes it easier on their families, too.”

McDonald noted that BHS can also videoconference with, say, a geneticist in Boston, when necessary, so that a patient doesn’t have to spend five hours on the Pike. “We can send the information and do an entire consultation in a room at the cancer center.”

Cooley Dickinson can videoconference with Boston as well — specifically, Mass General, the institution it merged with last year.

Mullally said the affiliation expands what was already a healthy collaborative partnership when it comes to cancer care, and what is being called the Mass General Cancer Center at Cooley Dickinson will relocate into a new building on the CDH campus in 2015. The cancer center will be operated by Mass General Hospital Cancer Center, he added, and all its physicians will become Mass General doctors.

Expanded services will include access to clinical trials at Mass General Cancer Center, an increased number of chemotherapy and radiation-therapy treatment protocols, increased access to genetic screening and counseling, and, of course, implementation of Mass General’s multi-disciplinary care model, where patients and their medical, radiation, and surgical oncologists can meet in a single appointment to plan all aspects of care.

Janet O’Connor, the center’s clinical nurse director, said the facility emphasizes both state-of-the-art treatment and services that impact body, mind, and spirit, with integrative therapies including acupuncture, massage, and Reiki.

She said the high-tech and high-touch elements of modern cancer care are equally important, reflecting the fact that reducing stress enhances healing. So, while CDH now has access to the type of cutting-edge care available at Mass General, patients will receive treatment in a building designed with a healing atmosphere in mind.

“We’re building a beautiful space,” O’Connor said. “The waiting room space will be very open with lots of light, and we’re creating a green roof with windows looking onto the roof and greenery.” The center will include 18 infusion areas, up to 12 exam rooms, and swing space for the support services, from nutrition to massage. “The idea is to keep the patient with us and bring our people to them, so they can have a consultation with a dietician, or with someone in occupational or physical therapy … we’re providing space where they can go to the patient.”

Patients and families were involved in the design phase, she added, and they will be further consulted on what kinds of committees or programs may be developed down the line.

Mullally also stressed the clinical-trial benefits of the Mass General affiliation, as MGH is one of the nation’s leaders in targeted therapy trials in melanoma, brain tumors, and other solid tumors.

“For the most part, if people want access to clinical trials, they need to drive to Boston. In the future, we’ll be able to provide many trials here, so it doesn’t require a ride back and forth,” he noted, adding that subspecialists at Mass General are easy to access when their consultation is needed. “They have an open-door policy; they pick up the phone.”

The cancer centers at Berkshire and SPHS are also embracing some new modalities, including the STAR (Survivorship Training and Rehabilitation) Program, an evidence-based education and training program that many hospitals and cancer centers offer to their administrative and clinical staff to develop more effective oncology-rehab services.

“It allows cancer patients, like those who have joint surgery, to go to rehabilitation faster and get better more quickly because of this enhanced focus on their rehab,” Fulco said.

The addition of rehabilitation oncology — combined with physicians’ new ability to coordinate care in one building — adds up to better quality of life for patients in Pittsfield, McDonald said.

“For so long, helping people survive was the primary outcome. As survival improves, quality-of-life treatment takes on additional meaning,” she said, which is why it’s important to add elements like exercise and rehabilitation; integrative services like yoga, Reiki, and acupuncture; and nutrition education. In fact, the center will invite guest chefs in for demonstrations on cooking healthy food.

Meanwhile, Leary said, “the Berkshires are a very good place for artists, and we’ve lined the walls of the cancer center with pieces of art by local artists. We’ve been able to display the talents of our community there.”

All the new cancer centers take the healing environment into account, Mullally said, and CDH is no exception. In the end, though, what drives the evolution of cancer care is that emphasis on bringing services to patients under one roof, and lessening their anxiety at what may just be the worst moment of their life.

“It makes it more convenient, and patients have better outcomes, if all the specialties are working together at the same time,” he said. “It makes for more patient-centered care.”