Hunterdon HealthCast
"Podcasts of health information from leading physicians and experts."
Interview with Barbara Tofani, Administrative Director of Hunterdon Regional Cancer Center
Dr. Robert Pickoff interviews Barbara Tofani, Administrative Director of Hunterdon Regional Cancer Center
Click above to listen now, or to download, right click on the following link and choose "Save Target As..." or "Save Link As..." InterviewWithBarbarTofani.mp3.
Dr. Robert Pickoff, Chief Medical Officer for Hunterdon Healthcare, interviews Barbara Tofani, Administrative Director of Hunterdon Regional Cancer Center. Barbara talks about cancer care at Hunterdon Medical Center and the cancer center.
.jpg "Barbara Tofani")
Barbara Tofani
Administrative Director
Hunterdon Regional Cancer Center
Transcript
Doctor Pickoff Hi, I’m Doctor Robert Pickoff, Chief Medical Officer for Hunterdon Medical Center. Today my guest is Barbara Tofani, Administrative Director of the Hunterdon Regional Cancer Center. She’s here to talk about cancer care at Hunterdon Medical Center and at the cancer center. Welcome Barbara. Thank you for participating.
Barbara Tofani
You’re welcome. It’s a pleasure to be here
Doctor Pickoff
Thank you. Can you give us a history of what has become the Hunterdon Regional Cancer Center at the medical center?
Barbara Tofani
Sure. About ten, twelve years ago, I guess it is now, the board of trustees of Hunterdon Medical Center made a decision to build a physical facility to house all of cancer services. Hunterdon had been providing cancer services for years before that. We had an affiliation with Fox Chase since 1993, but in 1999 the cancer center was built and it’s a facility that houses medical and radiation oncology so patients who need chemotherapy or radiation therapy come to the cancer center… and over the years it has grown tremendously, to meet the demand of the community.
Doctor Pickoff
So the program itself is about ten years old… and the… you mentioned the affiliation with Fox Chase. Many local cancer programs are affiliated with tertiary care cancer centers. What’s the importance of that? Why do we do that?
Barbara Tofani
Fox Chase is a national cancer institute designated comprehensive cancer center. Their entire focus is on cancer care, which is different than what an average community cancer center like Hunterdon’s is, although we do cancer care here, the rest of the services at the hospital are dedicated to cardiology and orthopedics and all of the general medical needs of the community. Fox Chase gives us the resources that we need to really define and create a very sophisticated high quality program without pulling from other important services that we need to provide resources for here in the community. They are a great resource for us in terms of research and prevention and outreach and risk prevention. What’s nice about Fox Chase and why we affiliate with Fox Chase over some of the other national institute facilities, is they’re one of the few NCI designated facilities that has a mission and a focus across a continuum of cancer. So they put as much emphasis on prevention and early detection as they do on treatment and research… which is important to us because our main goal is to try and keep our community as healthy as possible… and Fox Chase helps us do that.
Doctor Pickoff
Can you just tell us what is… when you say “NCI designated,” what does that mean?
Barbara Tofani
The National Cancer Institute has criteria that they’ve established for cancer centers around the country who have research as their priority… that they are looking to develop cutting edge and leading edge therapies… and they get national funding to support that research, and then that research is able to transition into community settings like ours.
Doctor Pickoff
So it’s a Federal designation…
Barbara Tofani
A Federal designation…
Doctor Pickoff
…of quality. I see. And is their participation from the affiliation with an NCI designated cancer center implies that the care at the regional cancer center mirrors the care that’s given at the affiliation… in our case, at Fox Chase. Are there protocols that are shared? Is there oversight of what we do here by them in any way?
Barbara Tofani
There is… there are protocols that are shared. There is oversight. We work with an advisory board from Fox Chase. We share our quality data with Fox Chase and they use and compare out quality data in a number of areas looking at survival and successive surgical procedures and the quality of our medical imaging and the quality of our breast care program… and they compare our data against other institutions within their network, against other national cancer institutions, and against facilities across the country… and what is interesting, is that across all areas that we share data with Fox Chase, Hunterdon is at least comparable, and in most cases, far exceeds the benchmarks and the national standards. So, the affiliation with Fox Chase really helps us to become, and to sustain a very high quality program.
Doctor Pickoff
Excellent. That’s great. Now who are the physicians that work at the Hunterdon Regional Cancer Center?
Barbara Tofani
In the cancer center itself we have medical oncologists and radiation oncologists. Doctor Brian Quinn, Doctor Ken Blankstein and Doctor Myron Bednar are three medical oncologists and then Doctor Andy Greenberg, John Bauman, and Doctor Orin Calen are three medical… excuse me… radiation oncologists. They are all, either Ivy League trained or trained at very good programs that emphasize cancer care. Doctor Ken Blankstein trained and did his residency and fellowship at Fox Chase. Doctor Orin Calen did his residency and fellowship at Memorial Sloane Kettering. These are physicians who have been exposed from the beginning of their careers… excuse me… to a high level of care and have been able to bring that level of care here to Hunterdon.
Doctor Pickoff
Great. Now, cancer care used to be fairly segmented, in the sense that you would see a medical oncologist… get an appointment a couple of weeks later with a surgeon… a couple of weeks after that with a radiation oncologist. What does having all the physicians under one roof benefit… how does that benefit the patient?
Barbara Tofani
Well, we tell patients all the time that life doesn’t stop just because you’ve been diagnosed with a cancer… and one of the reasons that Hunterdon Regional Cancer Center was built back in 1999, was to provide convenient care for a patient… make it as easy as possible because they still have to get their kids off bus… they still have to work… they still have to take care of aging parents who have needs. So we created this cancer center that is convenient to patients. So if they require medical and radiation oncology evaluation or surgical evaluation and medical oncology evaluation, the patient can come to one place and get all of the services… and then the physicians talk to each other after the patients leave. I just came from tumor board prior to this podcast where the physicians all talk as a group… medical oncology, radiation oncology, surgical oncology, the radiologist, the pathologist, the pulmonologist, the GI doctors… they all come together in the cancer center and they talk about… what is the best plan of care… not what’s the best plan of care based on a physicians area of expertise… but what’s the best plan of care for the patient based on the collective expertise of the cancer center. So the patients get a very non-biased, very appropriate clinical recommendation, which I think helps patients, because it becomes very confusing once they hear that word “cancer.”
Doctor Pickoff
Sure… no, absolutely… so its kind of an integrated approach as opposed to a segmented approach to the disease.
Barbara Tofani
Absolutely, and then what we have are care coordinators who provide assistance with the patients as they have to transition from one office to another office. So our care coordinators make life so easy for the patients. The patients really don’t have to think, because they can’t think. When they get that diagnosis of cancer everything just shuts down and even the most organized person finds themselves scrambling as to what to do next and where to go… and our care coordinators will just take that patient… will help make sense of what they’re hearing… help them get where they need to go in a timely manner… and give them some reassurance that they’re in the right place, on the right path, and doing the right thing for themselves… because we do get patients who say “I have no idea what I’m supposed to do next.” … and between our physicians and our care coordinators and the rest of the staff, we can help them, so they take the right next steps.
Doctor Pickoff
The care coordination has actually been a pretty big step for the regional cancer center. Who are they? Can you tell us a little bit about them?
Barbara Tofani
Pamela Vlahakis is our breast care coordinator and she’s been at Hunterdon in this role for about eight years and has done an unbelievable job of helping… mostly women… but we do have men who are diagnosed with breast cancer… get from their screening mammogram into a diagnostic mammogram and then to the surgeon or the radiologist for a diagnosis and then to whoever needs to seem them for their definitive treatment… and again, going back to our data, we look at those timelines with Fox Chase and we compare ourselves against national benchmarks… and Pamela and the rest of the team have done an unbelievable job of getting patients in and seen and taken care of appropriately, very quickly. Breast cancer is typically not a medical emergency but it is an emotional emergency. People want to know what’s going on and be able to get to where they need to go quickly and Pamela’s done an unbelievable job of that. We’ve taken that model that Pamela created and we’ve now applied it to other cancers… and Lori McMullen, who’s a Masters prepared oncology nurse now does the same thing with other diagnosis… people who have an abnormal colonoscopy, or people who have an abnormal chest x-ray… they thought they were going in for routine cataract surgery and their chest x-ray shows an abnormality. It may or may not be cancer, but until the patient gets a definitive word from the doctor, their fear is that it’s cancer… and Lori just takes them and just carries them through either to a diagnosis of cancer or, you know, works with the physician to say “You know what? We worked it up and it’s nothing. Go ahead, we’ll see you after your cataracts surgery.”
Doctor Pickoff
That’s a great service. That’s wonderful
Barbara Tofani
Thank you.
Doctor Pickoff
Barbara, I know that cancer programs are accredited and I know that they are accredited by the American College of Surgeons, but can you talk a little bit about the process and what that means to the program?
Barbara Tofani
Sure. Only about twenty five percent of the cancer programs in the country are accredited by the American College of Surgeons. Hunterdon has chosen to become accredited and we made that decision many, many years ago, because we wanted an outside organization to look over our shoulder and to make sure that the processes and the procedures and the services that we were offering were right and were timely and were evidence based. It is a lot of work to be accredited. It is a very labor intensive process. You are really always preparing yourselves to have somebody look over your shoulder. Many organizations just don’t want to have that type of oversight because it is labor intensive. It’s important to us because we are very close to what we do. We are very proud of what we do and we work very hard to make sure that we have the highest quality program… but we want someone to come in and validate that for us because we feel that’s what we owe patients. We owe patients the highest quality care we can possibly give them… and having accreditation really helps us to step up our game and make sure that we are constantly on our toes… that we never fall behind or don’t do something just because it’s too much work.
Doctor Pickoff
Right… and the program is fully accredited, and…
Barbara Tofani
We are fully accredited, and there is now a new breast accreditation, specifically looking at breast programs and Hunterdon is moving towards breast accreditation as well.
Doctor Pickoff
Great. Now, members of the community that have been driving by the hospital probably have noticed a bump out being constructed on the side of the cancer center. What’s that all about?
Barbara Tofani
We are… we have just installed a new linear accelerator. It’s a Varian Trilogy Linear Accelerator. This is a radiation treatment machine, so for patients who require radiation therapy it is a high energy treatment machine that actually shoots… very simply, shoots a beam of radiation very precisely to the tumor. We have a treatment machine now. We have a linear accelerator now that is about ten years old. The technology has advanced and Hunterdon made the investment to purchase a new linear accelerator. Because of the energy that’s required to run these machines, and the energy that actually comes out of the machine to kill the tumor, the room that it goes in is called a bunker or vault and what we just built is a vault that with walls that are three feet wide and then lined with lead. We will be able to do the same treatments that we do now, but in a much shorter time frame. So, something that might have taken us fifteen or twenty minutes to treat… a tumor that might have taken fifteen or twenty minutes to treat with our existing machine… we’ll be able to treat in about five or eight minutes. So it’s less time for the patient because again, patients need… they come in here for their radiation and then they need to go to work, or get a child off the bus, or go home and check on their parents… so we can get patients in and out very quickly now with this new treatment machine and we will treat our first patient the second week in March.
Doctor Pickoff
Oh good, so that’s exciting.
Barbara Tofani
It’s very exciting.
Doctor Pickoff
That’s great. So, for all of the facility, physicians, the energy to run the linac… how do patients in Hunterdon County fair in terms of their disease… outcomes, etc.
Barbara Tofani
That’s really the main thing, and what we tell ourselves every week when we all meet as a team is, “If we can’t treat patients better than anybody else does then there’s no reason for us to be in business.” And so we look at how our patients fair, and for the major diseases that we treat… breast… colon… lung… prostate… our patients do as well, if not better than, the state and national averages. We look at this on a regular basis. We report our data to the American College of Surgeons. We report our data to Fox Chase for them to compare against other national cancer institute facilities. We do not treat every cancer. There are some cancers that are better for us to refer down to Fox Chase or to another facility who has the ability to care for those patients… those rare types of cancers. We don’t treat those patients, but because we have a mechanism with out care coordinators to get them down to Fox Chase and then back up to us, we can still provide the best outcomes for our patients.
Doctor Pickoff
So that’s another strong reason for the affiliation…
Barbara Tofani
Absolutely.
Doctor Pickoff
… and that works very well?
Barbara Tofani
Absolutely.
Doctor Pickoff
That’s great… a couple other questions that I think people may want to hear about. People have access to clinical trials at Hunterdon.
Barbara Tofani
They do have access to clinical trials. We’re talking about research.
Doctor Pickoff
Research.
Barbara Tofani
There may be a reason for a patient to, either choose to enroll in a research study, or their physician thinks that that’s the best way to treat their cancer… and in the past, and in most community cancer centers, if a patient chooses or needs to go on a research protocol, they need to be transferred to another facility… to a tertiary facility. Here at Hunterdon, we have dedicated research nurses and a research team so that our patients don’t have to be transferred to another facility for a research protocol. And for anyone who’s had cancer, they understand how important that is because… part of the treatment is really believing in your treatment team, and being comfortable with them, and having faith in that research… in that treatment team. And if you now, all of a sudden have to break up that team and leave to go to another facility where you don’t know the nurses… you don’t know the physicians… it becomes very stressful to a patient… and we do know that stress can limit the effects of treatment and can effect tumor biology… so we’re very committed to having research here and providing as much of it as possible here. And Renee Falls and Linda Puffer, our research nurses… they work with Doctor Bednar and Blankstein and Quinn… and about thirty percent of our patients are involved in research in some form or another. We do a lot of prevention research studies so that we can keep people from ever having to come here for treatment.
Doctor Pickoff
Great. That’s the ultimate outcome… never getting the disease.
Barbara Tofani
That is the ultimate outcome. We really would love to put ourselves out of business.
Doctor Pickoff
Great… last question… Knowing what you know about cancer care, what is it that someone who gets the diagnosis should look for in a cancer program when he or she decides where to go for treatment?
Barbara Tofani
They should look for an accredited facility, first of all. When they talk to their physicians, their physicians should be following national guidelines and the physicians should be sharing those guidelines with the patients so that the patients don’t have to guess… “is this the right treatment?” And the physician can show them this is… that the treatment decision we’re recommending… it’s based on the research… it’s based on the national guidelines. And these national guidelines were put in place for community cancer centers like Hunterdon and for our residents, so that residents didn’t have to worry… that they were going to get sub-standard care in their local community. So they want somebody… and a physician who’s very willing to share those guidelines… that the patient is very comfortable with the treatment. But the treatment itself is very scientific. It is… I won’t say it’s simple, but… the treatment decisions are all based on evidence and research, so that’s not the biggest key, in my opinion, for choosing a cancer center. As long as a cancer center follows those guidelines, I think patients need to look for the other services that a cancer center offers.
Doctor Pickoff
Such as…
Barbara Tofani
Dietitians… dedicated oncology certified dietitians. Getting patients through treatments is very difficult sometimes. The treatment can cause some nausea. It can cause some vomiting. It can cause a depression, which lowers patient’s appetite… and most patients will have to discontinue treatment for nutrition reasons. And it doesn’t matter how good the treatment is that you offer. If you don’t have a dietitian who can help manage those nutritional needs and keep you on treatment, the service is… the chemo’s not going to do you any good… or the radiation’s not going to do you any good. You need social workers, financial counselors. This expensive is… this treatment is expensive. It is worrisome to patients. They need to make decisions about “how I am going to pay for this.” We have staff here who help patients with all of those things… and the staff is right on site… and I think that is very important. Until you go through it, you have no idea of how devastating those social issues can become… and how important it is to have somebody there for when you need them. And what we tell patients is, “We have dedicated oncology dietitians and social workers. We have risk assessment nurses who can help you if you’re worried that your cancer has a genetic quality to it… and that you might be passing a gene onto your children. We have dedicated finance people and billing people right in the cancer center.” And we tell patients, “You may never need our services, but we want to make sure you know that they’re there so that if you ever do need them you don’t have to go looking any place else.” We get calls from patients who have been treated at very large institutions in other cities in the northeast corridor who say, “I’m going to the best doctor but I had to stop treatment because I’ve lost too much weight and they don’t have a dietitian who can help me.” And we can help those patients… and we can provide the same service that that best doctor provided. It breaks my heart to see patients leaving our county to get services that we can provide as well or better than anybody else.
Doctor Pickoff
Right… well that sounds wonderful. It sounds like a great program. I want to thank you, Barbara, for joining me today to discuss the Hunterdon Regional Cancer Center. If you would like any more information on this topic, you can visit the Hunterdon Healthcare Web site at www.hunterdonhealthcare.org and if you need a physician, you can call the Hunterdon Healthcare physician referral service at 800-511-4462. Thanks very much for listening.