Dayton Physicians Network

Community Oncology Alliance advocates for support of independent cancer centers

Data from the 2018 Practice Impact Report shows that, over the past decade, 1,653 community oncology clinics and/or practices have closed, been acquired by hospitals, undergone corporate mergers, or reported they are struggling financially.

The mission of Community Oncology Alliance (COA) is to ensure cancer patients receive quality, affordable, and accessible cancer care in their own communities. More than 1.5 million people in the United States are diagnosed with cancer each year, and deaths from the disease have been steadily declining due to earlier detection, diagnosis and treatment.

Dayton Physicians Network

Dayton Physicians Network (DPN) is the premiere independent cancer treatment clinic in the Miami Valley. It’s not at risk of closing, and that’s due, in large part, to its partnership with COA and the advocacy work being done since the DPN COA Patient Advocacy Network Chapter (CPAN) opened locally three years ago.

>>> RELATED: Community Oncology Alliance gives local cancer patients a voice in their care

Rose Gerber COAAs of January 2019, according to the National Cancer Institute, nearly 17 million Americans survived cancer, and the majority of them are being treated in independent treatment centers, said Rose Gerber, director of patient advocacy and education for the Community Oncology Alliance. 

With independent treatment centers, patients receive highly personalized care. This isn’t just for the primary care when the patients are receiving cancer treatments, but also for the five-year follow-along period after the completion of treatment. Patients see the same doctors and nurses – even the receptionist is consistent. This is important, because beating cancer is an experience unique to each individual.

“Treating cancer isn’t just physical, it’s emotional,” Gerber said. “The continuity of care in the same setting is very important to patients.”

In a hospital setting, patients are often meeting new care providers each time they receive treatment, Gerber said. In this environment, the continuum of care is difficult to maintain. When you receive your care through independent centers, the doctors and nurses live in the community, might be the coach of a local little league team, and can often be seen in church on Sunday.

“Is that a part of your clinical care? No, but it matters to patients,” Gerber said.

Not only is the care received through an independent cancer treatment centers intimately personal, there are other benefits, as well. Care in independent centers is typically less costly. These centers are highly accessible, with patients parking and walking right in, allowing them to avoid garages and other challenges that come with care providers in larger settings. Independent centers are part of the community, typically featuring multiple locations found throughout the area. Dayton Physicians has 12 locations from Greenville to Middletown.

Raising awareness

Federal policies related to reimbursement procedures have a big impact on independent treatment centers. Without proper reimbursement, independent centers can’t stay open. COA provides independent cancer centers, like Dayton Physicians, with resources to advocate for the specific needs of cancer patients and for the support the centers require to remain operational.

Utilizing national and chapter-based events, policymaker meetings, networking opportunities, webinars and articles, COA’s Patient Advocacy Network (CPAN) provides an advocacy outlet for survivors and a voice that allows them to speak on behalf of patients and the need for independent treatment centers.

Recently, Dayton Physicians held a “sit in my chair” congressional meeting, where representatives from Ohio Senator Sherrod Brown’s office were able to experience being a cancer patient. Events like this help raise awareness among policy makers about the importance of maintaining patient access to independent care centers.

During mid-September, Dayton Physicians CEO, Robert Baird, Jr., RN, MSA, CASC, joined the rest of the COA Board of Directors in Washington, D.C., along with other community oncology practices and professionals from across the country. The group came together to tell Congress that patient assistance programs are critically important, need-based lifelines for cancer patients.

If you or someone you love hasn’t experienced cancer, you’re not only lucky, you may not understand the importance of making sure independent community cancer care remains available. COA knows how important independent community cancer treatment centers are and they are dedicated to making keeping doors open and fighting cancer one patient at a time.

“Dayton’s Physicians Network isn’t fighting for high-quality, affordable patient care alone – they are part of a national network of CPAN chapters across the country advocating for that care,” Gerber said.

New collaborative care model benefits urology patients

Dayton Physicians NetworkLean process workflow. It sounds like something straight off an assembly line – not words you expect to hear in a medical setting – but that’s exactly what’s happening at Dayton Physicians Network urology.

Cutting-edge, lean management and optimizing work flow practices are at the forefront of an innovative approach in collaborative care to treat patients, in light of a shortage of urologists in Dayton and across the United States.

There should be approximately 17,000 urologists based on our population. Currently, there are less than 10,000 active urologists in the United States, and over the next two years, that number will decrease to 8,000, due to retirement.

Not only is retirement decreasing the number of practicing urologists, but as the population ages, urologists are in greater demand – a convergence Dayton Physicians urologist David Key, MD, and his colleagues have been strategizing for the past few years.

The solution came when Key was talking with a friend, who shared how she uses workflow mapping in her business. He recalls their conversation, “I said, ‘Workflow mapping? Show me what you’re talking about.’”

The conversation inspired Key to do more research, eventually following a trail that led him to discover the Virginia Mason Institute in Seattle, Wash., where lean management processes are translated into the healthcare setting, with great success.

“They took the Toyota model of production, looked at efficiencies, and actually applied those practices to the health care industry,” Key said. “They even went over and visited Toyota in Japan. Virginia Mason has perfected the system to the point that Japanese hospitals are now sending their folks to Seattle for training.”

Key and a team from DPN visited the Virginia Mason Institute in 2018 and brought back the methodology. Team members have since been trained, and the new system was launched in July.

Shorter wait times for new patients
Before implementing the new approach to patient care, Key and his Dayton Physicians colleagues together would see an average of 250 new patients a month. “In only two weeks, under this new model, I saw 112 new patients, which extrapolates to over 200 patients for just one doctor over the course of a month,” he said.

Providing fast care for acute needs, the collaborative care model means new patients aren’t waiting five to six weeks to be seen. Instead, patients are being seen within 48 hours of an emergency room visit.

“The problem we were trying to solve for was how to address the needs of our community and allow urologists to take care of patients with the most need, while continuing to serve new patients,” said Dr. Key.

With this as the primary driver, urologists at DPN are now paired with nurse practitioners in a collaborative care model. One doctor is paired with a nurse practitioner and two medical assistants. Nurse practitioners see established patients, under the plan of care laid forth by the urologist. The urologist then is able to focus on surgeries and creating care plans for new patients. The office currently has four nurse practitioners, and Key foresees that number increasing to around eight.

Before being independently involved in patient care, each nurse practitioner participates in a three-month training program. “The training program within our group is pretty strenuous,” Key said.  “We are very pleased with our nurse practitioners. They are outstanding.”

What started as a solution to solve the growing shortage of physicians has produced surprising results that are, most importantly, creating better patient care.

“This model allows you to overcome the shortage of physicians, addressing patients needs in shorter time, which increases patient satisfaction and, ultimately, outcomes because you’re treating them in a much quicker fashion,” Key said. “It’s changing the face of how we see patients.”

Click here to learn more about urology care at Dayton Physicians Network, or you can call 937-293-1622.

Unconditional support carried this nurse through her cancer battle

Dayton Physicians NetworkAt age 37, Kim Grieshop, trauma nurse and mother of two young girls, faced what she says she feared most in life since her teen years – being diagnosed with cancer.

“When I was 17, my mom passed away from cancer…one month before my high school graduation,” Grieshop said. “Cancer has always been my Achilles’ heel. Being diagnosed myself was completely devastating.”

Unusual pain led to an OB/GYN appointment, in which doctors told her there were “no true red flags to worry about,” but they ordered a mammogram to be safe. Her mammogram results then led to an ultrasound and, ultimately, a biopsy.

The results: stage 0 breast cancer – the best-case scenario, Grieshop says. Her next step was meeting with surgeons and determining the course of action and recovery.

With her family history, Grieshop decided to be aggressive and opted for a bilateral mastectomy just weeks after her symptoms first appeared. Only two days after her surgery, when Grieshop thought she was over the hump, she received a call from her doctor. He told her the cancer was invasive in nature and would require chemotherapy.

“That was an extra punch in the gut,” Grieshop recalls. That’s when she selected James Sabiers, M.D., an oncologist with Dayton Physicians Network, for her cancer care.

For Grieshop, the bad news wasn’t over yet. Her tumor biomarkers were HER2+, making her cancer more aggressive in nature, which meant it also would require a year of immunotherapy.

Dayton Physicians Network“I’m not going to lie – there were days when I laid in bed and had a pity party for myself,” Grieshop said.

Chemo treatments were every three weeks and lasted four to six hours. While Grieshop feels medical advancements in the treatment of cancer made her symptoms more manageable, it was still a difficult time.

Grieshop relied on her faith; her husband, Joe; and the incredible support from Dayton Physicians Network to carry her through to recovery.

“My faith has really kept me going,” she said. “I’ve always had a relationship with Jesus, but this just intensified it. I don’t necessarily know why things happen all the time, but God has provided me some clarity that, even through the deep, dark valleys, He provides what I need, and He’s been faithful in life.”

As a mom of three- and five-year-old girls, a wife and trauma nurse educator, Grieshop said she had to put herself first, so she could heal and recover.

“My husband took on every role I couldn’t accomplish, and he did it all without saying a word,” Grieshop said. “Cooking, dishes, bathing the kids – he allowed me to be that person who needed to go lay in bed.”

Seeing both sides of care

Grieshop’s career as a nurse was both a blessing and a curse.

“I think it was a blessing I was a nurse, because I felt like I could advocate for myself more than maybe someone who didn’t have the same knowledge,” Grieshop said. “I work with medical colleagues, so I have a network of people I can reach out to.”

Conversely, becoming the patient meant she had to relinquish some of that control. “I had to let my own research go and rely on my doctors. I broke off my relationship with ‘Dr. Google,’” she said. “I’ve had to let go of being the nurse and allow my doctors to take care of me.”

Grieshop worked fulltime through her chemo, and she had a boss who never batted an eye when she said she wasn’t feeling well. “She was okay with my putting work last when I needed to.”

And if Grieshop was ever feeling down or overwhelmed or just plain “not well,” her support team at Dayton Physicians Network was always available. Grieshop felt comfortable calling her oncologist with any question.

“No matter what, I was able to call Dr. Sabiers, and he talked to me,” she said.  “That place is just so welcoming when you go in there.”

Grieshop recalled a day when she just wasn’t herself. The DPN receptionist noticed, which allowed Grieshop to be honest about her feelings. That’s when the woman gave her a green angel key chain, which had the birthstone of Grieshop’s mother.

“I just don’t think these things are coincidental,” she said.

Less than a year after being diagnosed, Grieshop is now cancer-free and still going strong.

To learn more about the cancer care options available through Dayton Physicians Network, call 937-293-1622.

How a medically integrated pharmacy benefits our patients

Dayton Physicians NetworkWhen it comes to your health, you don’t want to take any chances. You select the best physician, a state-of-the-art facility, and cutting-edge treatments and practices, but don’t stop there. Ensuring that your care provider is working with a medically integrated pharmacy is another box to check when it’s time to make important decisions about your health.

Whether you’re working with a physician for a chronic illness, life-threating condition or one-time injury, pharmaceuticals can be a big part of healing, but managing your medications can become tricky. You want to be sure you’re working with a pharmacist who understands the team approach to your treatment, and the best way to do that is to make sure you’ve selected to work with a medically integrated pharmacy.

A medically integrated pharmacy is a pharmacy that is “in-house” or part of a medical facility or practice. Unlike stand-alone retail pharmacies, medically integrated pharmacies provide many benefits to patient care.

Support for complex medication regimens: As medical treatments advance, pharmaceuticals are becoming more complex. What used to be one pill with breakfast, and maybe another at dinner, can now be doses several times a day, and even different doses on varying days of the week.

“Often, the medications prescribed in oncology care are just as complex as traditional chemotherapy,” said Joshua Cox, Pharm.D., director of pharmacy for Dayton Physicians Network. “Because they are taken in pill form, people assume they are safer, but that’s not always the case.”

Having access to a pharmacist who understands the complexity of the medications you’re taking is an important part of the team of professionals working to help you heal. You need a pharmacist who will do more than just confirm your dose is reasonable and that it won’t interact with other prescriptions.

Access to real-time physician data: When your pharmacist is working in-house with your physicians, he or she has the ability to see to the same data as your doctors. “We can see all the physicians’ notes, lab values, imaging and scans, so we are seeing, in real time, the same information every other health care provider on your team is seeing,” Cox said.

Access to real-time information from a patient’s medical record means the pharmacist can help doctors and nurses make decisions that are the best for the patient.

Ensures better patient outcomes: Medication adherence and education is a large component of the medically integrated pharmacy method. With the team approach, pharmacists work with patients to counsel them about taking medications and what the side effects might be, which can help them monitor whether patients are taking medications correctly.

If side effects or a reaction does occur, the team approach allows these issues to be recognized quickly. With support from the physician, the medication can be safely stopped, if necessary, and side effects can be more effectively managed.

“If you can’t take a medication because of its side effects, it certainly cannot be effective,” Cox said. “With our robust medication adherence program, we can ensure patients are staying on their meds, making the medications more effective and leading to better outcomes.”

Provides cost savings and reduces waste: When it comes to complex medications with serious side effects, such as those administered for cancer treatment, physicians often make changes to help patients feel their best and heal more quickly.

“Doses are frequently changed by physicians, either because it’s intended or because the condition changes in some way,” Cox said. “When that happens, if the prescription is being filled at a pharmacy elsewhere, the delay in communication means the medication could be filled under orders that are no longer current.”

In situations like this with expensive drugs, one incorrectly filled prescription can equate to thousands of dollars thrown away. With a medically integrated pharmacy, pharmacists have access to information the moment the physician makes changes, meaning unnecessary prescriptions are never filled, reducing waste and saving money.

Don’t overlook the benefits of being able to include your pharmacist as a member of your health care team. With the integrated approach, you have the support you need for complex medications, could be better for the health of your body and your budget.

Click here to learn more about the pharmacy services available through Dayton Physicians Network, or call 937-245-6320.

Musician and physician: DPN urologist excels in both

When you hear about a surgeon who also is an outstanding musician, it shouldn’t surprise you. After all, both require a high level of technical skill, complex thinking and persistence to master. Some studies have even found increased grey matter in the brain, which is associated with increased skills, as a result of musical training.

For Michael Yu, MD, a urologist with Dayton Physicians Network and a first-generation Asian American, playing an instrument was a requirement set by his parents when he was a child.

“If I wasn’t a physician, I’d probably be a musician,” he observed. Dr. Yu can play seven instruments, including piano, clarinet, three saxophones, guitar and violin.

While playing an instrument was mandatory, having an actual career in music wasn’t a possibility he felt he could consider. Dr. Yu said he always knew he would become a doctor. His father, his aunts and uncles on his mother’s side, and his grandparents—all of them are physicians.

“For me, it was never really a question,” Dr. Yu said about his career path. He considered a career as a trauma surgeon for a short time before being influenced by two of his uncles to consider urology.

Dr. Yu said urology allows him not only to care for his patients, which is why he enjoys being a doctor, but also to develop lasting relationships with them. Many of the conditions Dr. Yu treats are chronic, allowing him to provide a continuum of care and to work with his patients in developing treatment plans that allow for their input. 

From removing kidney stones and helping older patients with enlarged prostates, to treating conditions like diabetes and high blood pressure, Dr. Yu truly enjoys the work he does.

“It gives me a good sense of satisfaction to be able to help people and show them the results of what we do,” Dr. Yu said, who often presents patients with kidney stones removed during their surgeries.

When Dr. Yu is in the operating room, music is still a part of his routine. “I listen to pretty much anything but rap and country music,” he said.

Choosing to practice in Dayton

Dr. Yu performed his undergraduate work at Dartmouth, his medical degree is from NYU, and he completed his residency at Washington University in Saint Louis. He was offered a job at the Cleveland Clinic and chose Dayton Physicians Network instead. Dr. Yu became the first urologist in Dayton to perform robotic pyeloplasty for ureteropelvic junction obstruction, which removes a blockage occurring where the kidney meets the ureter.

“I think Dayton is a very good medical community that is underrecognized nationally,” he said when asked why he settled in the Miami Valley. “I would put us up against Ohio State, Cincinnati and the Cleveland Clinic.”

At the end of a long day, of which there are plenty, Dr. Yu says he enjoys playing the piano, watching movies, hiking and even playing video games from time to time.

“I find myself with less and less free time to spend with my wife and kids,” said Dr. Yu, who recently celebrated his 20-year wedding anniversary and has two boys, ages 15 and 18. “Being involved in medicine isn’t easy…and it’s not really for everybody. You have to be completely committed to it.”

Between paperwork and preparing for his surgeries the next day, Dr. Yu said he often works two to three hours each night after his family goes to bed. With the amount of labor he puts in, he doesn’t see either of his sons carrying on the family tradition of becoming a physician. In fact, one of his sons is also interested in music, and Dr. Yu said he would support whatever direction their lives take them.

“People say, ‘You’re in it for the money,’” Dr. Yu said, “But I really do like what I do. Actually, I love what I do, and I think I’m pretty good at it. I’d like to keep doing it as long as I can.”

If you’d like to make an appointment with Dr. Yu, contact Dayton Physicians Network at 937-293-1622.

Breast cancer survivor says a positive attitude is the key

Dayton Physicians NetworkAt age 53, Patty* went from a stage three breast cancer diagnosis to complete remission in six months. She’ll tell you it wasn’t an easy road, but with the support of her doctors and Dayton Physicians Network, she is feeling better every day and thinking about the future again.

“I was the first female in my family to be diagnosed with breast cancer,” Patty said. “They say it’s genetic, but that’s not always true.”

When Patty noticed her breasts began to look abnormal, she did a little internet research, only to discover she had all five of the classic signs of breast cancer. She contacted her doctor and was referred to a specialist.

“You feel distraught,” Patty said about her diagnosis. “You feel like your life is finished and wonder if the cancer is going to take over. You wonder how long you have to live. Whether it’s stage zero, one, two or three, it’s very distressing.”

For her treatment, Patty selected Dayton Physicians Network, a multi-specialty network that provides comprehensive cancer care and urologic care services at 12 locations throughout the Miami Valley.

Before treatments begin, patients with DPN are assigned a nurse to thoroughly review the treatment plan and possible side effects. Patty spent over two hours with her nurse, who walked her through the onslaught of new and overwhelming information and terms.

Treatment started almost immediately. In addition to surgery, Patty underwent six cycles of chemo, each lasting between four to six hours, every 21 days, and then endured 28 consecutive days of radiation.

No one wants to go through cancer treatment, but certain things can make the experience more manageable. The Dayton Physicians infusion room located in Miami Valley South is lined with windows and flooded with natural light. Patients are made comfortable in reclining chairs, with options for heated blankets, snacks and beverages.

“A lot of people like it there and request that location,” Patty said. “It’s convenient, with good access from the highway, and parking is great.”

Support system + positive outlook

If you ask Patty what got her through the treatment, she’ll tell you that, in addition to a great support system from her sister, close friends and DPN, she kept a positive attitude.

“I guess I didn’t want the cancer to take over – I wanted to beat it,” Patty said. “I didn’t sit and dwell on the fact that I had cancer. You have to think about things that make you happy.”

And it worked. On her birthday this year, Patty received the “all-clear” and had a whole new reason to celebrate. A few weeks later, her chemo port was removed.

“No more port means no more treatment,” Patty said of this major milestone in her care. “I’m done.”

Even with the all-clear, Patty will have routine meetings with her oncologist and surgeon. She’ll undergo regular blood checks and work diligently to maintain her health.

Patty’s after-care included her participation in the Dayton Physician Network survivorship program, which is designed to help patients navigate the challenges faced during recovery. Patients are made aware of late and long-term effects of treatment and are supported with after-care options specific to their type of cancer.

As a part of the program, Dayton Physicians screens for a variety of issues including anxiety, depression, distress, changes in cognitive function and memory, hormonal or sexual problems, even financial concerns. A survivorship care plan is created, documenting the patient’s cancer diagnosis and treatment, and the patient and all of their care providers receive copies.

Patty also works with a personal trainer to help her incorporate exercise into her post-treatment lifestyle. Not only does this have health and preventative benefits, but it also helps her overcome some of the muscle weaknesses caused by treatment.

Patty recommends advocating for yourself not only during your care, but also with your employer to be sure work is never a reason to delay or miss a treatment. She also says your attitude is paramount.

“Stay positive and don’t focus on the negative,” Patty said. “There are treatments that work. It takes longer for some than others, but doctors know so much more now than they used to.”

Ironically, Patty says she hasn’t always had such an upbeat outlook.

“Cancer changed that a lot,” she said. “I try to be more positive now. When I see an issue or a problem, I look at everything I’ve been through and think ‘I can handle this—I just beat cancer!’”

For more information about cancer treatment options with Dayton Physicians Network, call us at (937) 293-1622.

* Name changed to protect patient’s identity

Cancer 101: Understanding the basics

“You have cancer.”

Dayton Physicians NetworkThose are the words that no one wants to hear from their doctor. Unfortunately, far too many do.

According to The American Cancer Society, an estimated 1,685,210 new cases of cancer were expected to be diagnosed in the United States in the last year alone.

The good news is that, with early diagnosis and treatment, the number of people living beyond a cancer diagnosis is expected to rise to almost 19 million by 2024 (up from nearly 14.5 million in 2014).

Dayton Physicians NetworkKnowledge is power
One of the scariest things about being diagnosed with cancer is all the unknowns. Gaining some understanding about the various stages of cancer and how it’s generally treated can go a long way toward alleviating some of the fear and anxiety.

Cancer staging
“Staging helps doctors to know where a cancer is located, if and where it has spread, and whether it is affecting other parts of the body,” explained Mark Marinella, MD, FACP, a specialist in the hematology and medical oncology department of the Dayton Physicians Network. “With this information, doctors can plan a course of treatment, including the type of surgery and whether chemotherapy or radiation are needed.”

Most cancers have four stages: stage I (one) to IV (four), with four being the most advanced.

  • Stage I: Often called early-stage, Stage I is usually a small cancer or tumor that has not grown too deeply into nearby tissue and also has not spread to the lymph nodes or other parts of the body.
  • Stage II and III: These stages indicate larger cancers or tumors that have grown more deeply into nearby tissue and may have also spread to lymph nodes but not to other parts of the body.
  • Stage IV: Also called advanced or metastatic cancer, this stage indicates that the cancer has spread to other organs or parts of the body

“Treatments for cancer vary greatly, with the most common being surgery, chemotherapy and radiation. The stage of the cancer will help to determine the best course of treatment,” said Dr. Marinella.

  • Surgery can be used to take out the cancer (tumor) and occasionally to remove some or all of the body part(s) affected by the cancer.
  • Chemotherapy (also called “chemo”) is the use of drugs to kill cancer cells or slow down their growth. It can be given intravenously or as pills to swallow. Chemotherapy treatment is useful in treating cancers that have spread.
  • Radiation also is used to kill or slow the growth of cancer cells and can be used alone or with surgery or chemo. Having radiation treatment is similar to getting an x-ray.
  • Immunotherapy: Newer drugs, called “checkpoint inhibitors,” are now available that stimulate the immune system to fight cancers such as melanoma, lung cancer, kidney cancer, bladder cancer, and head and neck cancers.
  • Targeted therapies are antibody treatments and other oral drugs that attack a certain abnormality in the cancer cell.

Dayton Physicians Network

During diagnosis, Dayton Physicians Network routinely checks genomic profiling on many patient tumors. This procedure looks for genetic changes and abnormalities that may help determine a course of treatment and allows DPN to find trials in which a patient can participate.

Should I get a second opinion?
“Unless a patient really wants one, I generally don’t recommend it,” said Dr. Marinella. “Where I might recommend a second opinion is more of a physician-driven thing. For example, if I see something that is very rare or if a patient has received all the treatment I can give, I might consult with another physician on a possible clinical trial.”

The diverse areas of expertise and specialties in cancer care that exist among the doctors, as well as the access they have to cutting-edge technology and clinical trials, allows Dayton Physicians Network to provide patients with timely and comprehensive, patient-centered care. In addition, with 13 practice locations from Greenville to Middletown, patients can receive cutting-edge cancer care while remaining close to home.

Click here to learn more about Dayton Physicians Network cancer care, or call 937-293-1622937-293-1622.

Cancer survivorship program provides continued support after treatment

Dayton Physicians NetworkDealing with cancer can be difficult enough, but often the aftermath can be just as troubling. Survivors not only have to deal with the disease, but also may struggle with lasting physical and emotional effects of treatment. Patients who felt they had a great deal of support throughout treatment often find it hard to adjust to a new way of life and the challenges they may face in the recovery phase.

Dayton Physicians Network offers a survivorship program to help patients navigate these difficulties and continue supporting them after treatment. Elizabeth Delaney, DNP, APN, FNP-BC, is a nurse practitioner with the program.

“We have had the opportunity to witness people experiencing the long-term effects of therapy, as well as impacts to their quality of life from their treatments,” Delaney said. “Cancer survivorship is about addressing the impact of cancer and treatment for the individual, particularly after those initial therapies are completed.”

Rotating through four Dayton Physicians Network locations, Delaney sees patients who are in stages 0 through 3 with curative therapy at the Survivorship Clinic. Right now, that includes only patients of breast and colon cancer, but DPN hopes to expand to include lung and prostate cancer patients in the near future.

Once curative therapy is completed, patients have the opportunity to complete a National Comprehensive Cancer Network (NCCN) survivorship assessment to determine what issues may need to be addressed post-treatment. Dayton Physicians screens for a variety of issues including anxiety, depression, distress, changes in cognitive and memory, hormonal or sexual problems, even financial concerns.

For example, some treatments have delayed impacts to the heart and lungs, so patients may need to be aware of the potential for shortness of breath or swelling in the arms. And breast cancer patients might experience lymphedema, a swelling in one of the legs or arms. The patient may not even be aware of these conditions, but they all affect long-term recovery.

The next part of the visit is to create a tailored Survivorship Care Plan, a summary document about everything regarding the patient’s cancer diagnosis and treatment. A copy is given to the patient and all of their care providers, such as the surgeon or other specialists.

Finally, staffers review the current national recommendations for healthy lifestyle choices and ways to reduce the potential for recurrence of the patient’s original cancer or development of other types. For example, helping them to stop smoking, integration of a healthier diet and exercise, mental health counseling, and regular spirituality practice. Research has shown that all of these practices improve quality of life, reduce anxiety and depression, and in some cases, reduce recurrence of cancer.

Delaney says that patient response to the Survivorship Clinic has been overwhelmingly positive, and they are grateful to have the plan review. “I articulate common concerns for cancer patients, like emotional and mental health, weight gain, smoking cessation, fertility issues, and so on,” she explained. “We go through all of those and, often, just showing people that these are common concerns can help reduce the ‘suffering in silence.’ It feels good to them to know they’re not uncommon.”

“Being able to articulate their story and have someone listen to them can make a big difference,” Delaney said. “Sex, for example, is a big topic that comes up. Women who have had mastectomy may suffer with body image changes, and the effects of chemotherapy and hormonal drugs can lead to other related complications.”

The most common concerns and questions from patients tend to depend on the stage of cancer and the age of the patients. Understanding the common concerns, however, is helpful across the board. Many are interested in the impact of healthy lifestyle and want input from the providers on those choices.

The greatest barrier to helping survivors through the challenging time following treatment is that they often do not schedule the visit. Patients have expressed the value of the service, from the information provided and the overall support offered, to keeping office visits to a minimum. When a provider says you may be eligible for a survivorship visit, take advantage of it.

For more information about the Dayton Physicians Network Cancer Survivorship Clinic, call 937-293-1622.

Technological advancements lead to more effective radiation treatments

Dayton Physicians NetworkThe field of radiation oncology is a high-tech world, where medical science and physics are orchestrated together to provide the best possible outcome for cancer patients. At Dayton Physicians Network, our radiation oncology staff is working to keep all of our clinics equipped with state-of-the-art technology and expertise. The goal is personalized treatments for our patients, making sure that every patient receives the best possible care and is able to maintain his/her quality of life.

Madhup Gupta, MS, DABR is the Director of Medical Physics and Chief Medical Physicist at Dayton Physicians Network. It might seem unusual to have a physicist working in a medical field, but in the world of radiation oncology, his position is vital.

As a medical physicist, board-certified by American Board of Radiology, Mr. Gupta calibrates the linear accelerator, which delivers a radiation dose to a highly specific location.

Dayton Physicians Network“A physicist is in a cancer clinic because of the presence of highly sophisticated radiation-producing machines,” Mr. Gupta explained. “Our main job is to calibrate and quantify the radiation that the physician wants delivered to the patients. We cannot see, hear or feel radiation, however, we use it daily to stop the spread of cancer and kill cancer cells anywhere inside the body.”

Another aspect of the job is radiation safety – a team of seven board-certified medical physicists make sure that all treatments are safe and effective. They ensure that our patients and staff stay safe during the complex high-energy radiation delivery to the tumor.

Some of the newest technology coming to Dayton Physicians Network is called RapidArc® with robotic couch. Compared to Cyberknife® technology, the RapidArc® conforms the radiation to the shape of the tumor and “paints” the radiation with a beam in an arc over the tumor with different entry points around the body. This allows a highly modulated dose delivery precisely concentrated to the tumor location in rapid beam sequence within a minute for a full arc. So, what would take an hour to accomplish with Cyberknife can be done in about ten minutes (including the setup time) with RapidArc®.

That level of precision also requires the patient to be positioned exactly right, and the newer technology has provided a solution to that, as well. The patient is CT imaged (CBCT to view 3D anatomy) just prior to their treatment, and the robotic treatment couch (with 6 degrees of freedom) can position the patient to under one degree or one millimeter. This precision in tumor localization allows for accurate tumor dose delivery while sparing the surrounding normal organs. Radiation doses are planned and calculated by a medical dosimetrist, who is certified by the American Association of Medical Dosimetry.

Dayton Physicians Network is the first in Ohio to receive a third-party accreditation from the American Society of Radiation Oncology for all six radiation clinics in and around Dayton.

During a year-long process, DPN gave access to ASTRO APEx® radiation oncologists and medical physicists to review all procedures and processes, treatment planning and delivery. They looked at everything, from cancer diagnosis and staging, to machine quality control and staff certifications. A team consisting of radiation oncologists and radiation physicists visited our six radiation clinics and interviewed our experts. Accreditation was awarded at the end of 2016 and is good until 2020.

We are also a Certified Member of MD Anderson Cancer Network for Oncology Program. MD Anderson is the nation’s premier cancer treatment and research clinic, based in Houston, Texas. All our radiation and medical oncologists have also received certification by the M.D. Anderson Cancer Network, giving physicians access to the latest cancer care options.

With six outpatient radiation sites, Dayton Physicians Network is making it easier for patients to get the best possible treatment closer to home. “It’s good to have our treatment centers spread out where patients don’t have to drive too far for their treatments,” said Mr. Gupta. “They can get the top-notch cancer care closer to home.”

For more information or to schedule a consultation, contact Dayton Physicians Network Radiation Oncology and Imaging at 937-771-2422937-771-2422.

(All images courtesy of Varian Medical Systems, Palo Alto, CA)

Hydrogel Spacer Helps Protect Healthy Tissue During Radiation Therapy

Dayton Physicians NetworkAccording to the American Cancer Society, urological cancers, which include cancers of the bladder, kidney, prostate and testicles, are relatively common. In the United States, bladder cancer is the fourth most common cancer among men and ninth with women. More than 50,000 new cases of bladder cancer are diagnosed each year.

In younger men, ages 15 to 44, testicular cancer is most prevalent. But one out of every 10 men, most over the age of 50, will develop prostate cancer at some point, making it the most common cancer experienced by American men.

Treating urological cancer involves therapy using heavy doses of precisely administered radiation. Some of the major challenges to the success of the treatment include complications caused by the high concentration of radiation needed in order for the therapy to be effective. The challenge is to deposit a large enough amount of radiation at the proper location without doing harm to the other areas, including the bladder and rectum.

Since the ultimate goal of radiation therapy is to maximize the dose of radiation administered in order to gain the greatest benefit in the shortest amount of time, that also means more potential damage to the tissues surrounding the treatment area.

In order to deal with localized disease such as prostate cancer, it’s important to put as much space as possible between the organ being treated and other areas, in particular the rectum. Now, a new injectable material can artificially and temporarily increase that space, to help protect the rectum from the harmful radiation so vitally needed to treat localized prostate cancer.

SpaceOAR is the name of an absorbable hydrogel used to create a space between a diseased prostate undergoing radiotherapy and the rectum. The barrier provides protection of the rectum during the radiation treatment, minimizing complications resulting from damaging otherwise healthy tissue. The “OAR” in SpaceOAR stands for “organ at risk” – in this case, that organ would be the rectum.

Using ultrasound, the doctor locates the area where the SpaceOAR is to be injected. The hydrogel is made up of two liquids that combine to form a soft gel mostly made of water, so it can be safely used without injury or allergic reaction. In clinical trials, patients who were given the hydrogel spacer reported significantly reduced rectal pain and less severe, long-term rectal complications.

Patients may be awake or under general anesthesia during the procedure. This minimally invasive hydrogel stays intact during the radiation therapy, but over time, it is gradually absorbed by the body, once the therapy is completed.

“Giving more distance between rectal wall and prostate enables the use of a high dose of radiation to treat cancer in the prostate, but with a much lower dose going to the rectal area. This provides a significant benefit to the patient by preserving the healthy tissue in the surrounding area,” explained Douglas Ditzel, D.O., radiation oncologist with Dayton Physicians Network.

A special needle is fed by two syringes, which merge into one applicator. The hydrogel is injected and solidifies in about 15 seconds within the space, spreading out the affected tissue. The gel will remain there from three-to-six months, providing a space of about one-and-a-half centimeters, expanded from the original area of approximately three millimeters.

“So far, the procedure has been very effective,” Dr. Ditzel said. “It takes about 20-to-30 minutes, and patients are home and resuming normal activity right away.”

SpaceOAR helps to preserve healthy tissue and maintain rectal, urinary and sexual health and quality of life. Because of this preservation, the procedure also minimizes side effects associated with prostate cancer radiation therapy, such as rectal pain, bleeding, and discomfort.

Not all patients and situations are right for SpaceOAR. If the cancer has spread to the surrounding tissue or moved somewhere else within the body, the hydrogel will be of little use. In this situation, the radiation oncologist must examine the case and determine the best course of action, based on the specific patient’s needs.

If you are undergoing radiation therapy for prostate cancer and would like to learn more about how SpaceOAR can become part of your treatment plan, call Dayton Physicians Network at 937-293-1622937-293-1622 or click here.