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Cancer Currents for July 2012

News and Notes from the Director
Photo: Mark Israel, Director of Norris Cotton Cancer Center

Federal funding is the underpinning of cancer research conducted at the nation's academic research centers, and the Norris Cotton Cancer Center receives almost 75% of its budget for research from the National Institutes of Health (NIH), the Department of Defense, and the Centers for Disease Control. These are the major sources of federal funding for biomedical research at all the nation's major cancer centers. This has been money well spent. Death rates for the four most common cancers, those arising in prostate, breast, lung, and colon, as well as the death rate for all cancers combined, have been declining for the past two decades and continue to decline. There have also been remarkable advances in cancer prevention: Cancer incidence has declined annually since the early 2000s and continues to decline. Research supported by the NIH has been essential for the numerous advances that these remarkable statistics reflect as well as for the relief of pain and suffering that patients experience when receiving more effective therapy.

Despite these advances, it is estimated that men have about a one in two chance of developing cancer at some point in their lives, and women have a one in three chance. Cancer is a huge public health problem. The National Cancer Institute has recently estimated that the cost of cancer care to the American public exceeds $100 billion annually. Additionally, an annual loss of more than $135 billion results from lost productivity caused by the premature death of cancer patients. These losses contrast sharply with the positive impacts of cancer research on the economy: Virtually all federal funding for research is returned to the economy in terms of salaries for high technology workers and the purchase of goods and services.  In New Hampshire alone, federal funding of cancer research at NCCC brings about $43.5 million into the state each year, and NIH in total provides almost $90 million for funding within New Hampshire. I estimate that more than 85% of that is spent locally. We estimate that this money provides 690 jobs, and nationwide this number is thought to exceed 163,000 jobs.

What better investment for our federal dollars than cancer research?  Yet the growth of federal funding for biomedical research slowed in 2003, peaked in 2010, and decreased in 2011.  Even more important is the decrease in buying power of research dollars adjusted for inflation. Since 2003, the peak funding year in dollars adjusted for inflation, the buying power of federal funding for research has diminished by almost 25%. The FY 2012 budget and the President's proposal for FY 2013 are each $4 billion lower in purchasing power than was provided in 2003 and are at the lowest level since FY 2001.

I and others from Dartmouth have been working hard to emphasize to our leaders in Washington the importance of continuing high levels of federal funding for cancer research. Last week, I and others from NCCC joined executives of the American Cancer Society at a briefing in Nashua with representatives from New Hampshire's Congressional delegation to make exactly this point. It is difficult to predict the effect of that effort, but it was clear that our representatives want to hear from their constituents regarding what budgetary initiatives are important to them. Write, call, email, or visit members of our federal delegation. We are preparing a page on the NCCC website that will facilitate your informing our Congressional representatives of your opinions regarding issues such as federal funding for cancer research. But don't wait for this page to be in place. Contact your representative now. If you are unclear how to do that, call my office, and we will lead you through the process. Your voice counts. Make your support for full funding for cancer research clarion clear!

Mark Israel, Director



Cancer Patients Give NCCC High RatingsCheckmark graphic

Norris Cotton Cancer Center patients rated their overall satisfaction with an outpatient visit significantly above the averages for other Dartmouth-Hitchcock outpatient services, with the highest ratings being awarded for care provided in pediatric oncology and St. Johnsbury.

Lebanon's Pediatric Hematology/Oncology had the highest score of all sections and exceeded outstanding scores obtained last year. Ratings for patient satisfaction at  NCCC Hematology/Oncology and NCCC Radiation/Oncology located in St. Johnsbury ranked in  the top five of 56 DHMC Sections evaluated  for a year starting in April 2011.  Radiation Oncology at NCCC in Lebanon (2K) appeared in the top 10 and achieved marked improvement in the last year, compared to the prior year. Hematology/Oncology (3K) was rated in the top 20 sections for the 12 month period studied and significantly exceeded the DHMC mean.

The patient's perception of overall satisfaction for an outpatient visit reflects the full visit experience: making an appointment, checking in, waiting to see their provider, the care they received, and checking out.

Congratulations go out to all our staff for treating patients with compassion and respect. Your responsiveness and attentiveness make a difference. Thank you for working together to care for those with cancer and their families. You are an inspiration.

Shukhov Tower graphicNCCC Shared Resources Purchase State-of-the-Art Instruments

NCCC Shared Resources will acquire four new instruments over the next three months. The Genomics and Microarray Shared Resource will purchase a Personal Genome Machine (PGM) and an Ion Proton Sequencer, both from Life Technologies. These purchases are aimed at reducing the price and turnaround time for a variety of DNA deep-sequencing applications. Instrument capabilities range from targeted gene sequencing and ChIP-seq on the PGM to whole human genome sequencing using the Ion Proton. The instrument run times are measured in hours not weeks; prices will be in hundreds not thousands of dollars. This purchase marks a significant advance in the Genomics and Microarray Shared Resource's service catalog.
In anticipation of FDA approval of the PGM the Pathology Shared Resource will purchase an additional PGM for CLIA certified applications.

The Immune-monitoring and Flow Cytometry Shared Resource will acquire and third MACSQUANT fully automated flow cytometer, from Miltenyi Biotec. This purchase is in response to an increase in demand for automated multi-color flow Cytometry. The MAXQUANT is capable of multi-parametric cell analysis via three lasers and up to ten optical channels. The instrument is fully automated and able to analyze 96 samples unattended in a single run.

Hello to Kathleen Smith

It is with great pleasure that we welcome Kathleen M. Smith as our Cancer Center Lab and Facilities Coordinator.  Kathy will play a vital role in facilitating the work of multiple labs operating together on Rubin 6 and 7.    She will also serve as our Cancer Center Fire and Safety Marshall for Cancer Center space on Rubin 6, 7, and 8.

Kathy comes to this position with a wealth of relevant training and experience.  She has a Bachelor of Arts degree in Biology, from Kenyon College in Ohio, and a Master of Arts degree in Teaching from Rhode Island College.   During the past six years Kathy worked as a Research Assistant II in the Cancer Center's DartLab Shared Resource under the direction of Dr. Jackie Channon-Smith. Kathy will be located on Rubin Building Level 6 in the space occupied by her predecessor, Ray Dauphinais.  Her phone number will be 603-653-6047. 

Goodbye, Alas, to Vivek Samnotra

And just as we welcome new staff, we regret the departure of Vivek Samnotra, MD, Medical Director and staff oncologist with the NCCC satelite clinic at Frisbie Memorial Hospital in Rochester. Vivek will be leaving at the end of June to become Medical Direct with Parexel International, a CRO based in the Boston area; his last clinic day will be June 30th.   Vivek and his family will be relocating closer to his extended family in Massachusetts. 

He joined NCCC/DHMC in 2001 and helped build a Hematology/Oncology practice for NCCC at Frisbie. He also established an outreach site at Huggins Hospital in Wolfboro, NH, and focused his clinical research on patients with Locally Advanced or Metastatic Adrenocortical Carcinoma.

Please join us in wishing Vivek well in his new post

Bone Marrow Biopsies to be Performed at OSCBone marrow

Beginning in August, bone marrow biopsies will be performed at the D-H Outpatient Surgery Center (OSC). The OSC is located on the DHMC campus on LaHaye Drive, less than a mile from the intersection with Route 120. This transition increases safety, access, and quality of care. The OSC is best equipped to support sedation for the procedure.

Historically, bone marrow biopsies have been performed in the infusion suite or in PACU. Relocation will change the routine for existing patients and families. Some of the differences patients and families will notice beyond the location include some new precautions associated with the sedation options offered at the OSC.

For patients' safety, they must arrange for a responsible adult to:

  • accompany them on the day of the procedure
  • remain on-site at the OSC throughout their stay
  • provide transportation home after the procedure
  • remain with them for at least 24 hours after the procedure

Please anticipate questions and handle any concerns with patience.

How to handle problems and complaints

It can be hard to handle someone when they are unhappy.  But there are some tried and true tips that can help smooth out the experience for everyone involved.  If you encounter difficult questions or negative concerns, keep these tips in mind.

  • Listen carefully to concerns
    Show positive, open body language. Nod.  Restate or affirm if you need to. Don't interrupt.
  • Empathize with what the patient of family member is experiencing
    Take a minute to empathize with the patient and acknowledge that you understand.  For example:
    "It sounds like this has really messed up all your plans to see to some urgent personal business. I can imagine how frustrating that would be."
  • Apologize that this is their experience
    Sometimes people have trouble with this one. But what makes it easy is that you are not apologizing for anything you have done, you are expressing regret about the individual's experience. For example, "I am sorry this has wrecked your whole morning."  "I want to let you know this is not what we want your experience to be."  "I am sorry this has been such a frustrating experience for you."
  • Leap into action
    Do whatever you can to assist. Pick up the phone to make arrangements. Escort someone to where they need to be. Offer and follow through on investigating something that didn't go as it should have.
  • Thank them

Don't forget to express gratitude. There are many ways you can do this: "Thank you for your patience," or, "I appreciate your flexibility while we work out this new system."  When thanking someone, you can also offer a small token of appreciation, such as a cold beverage or café gift certificate. "You have been so understanding about this. I want to offer you this (coupon for a free coffee) to let you know how much I appreciate your patience."

Terri and RebeccaMaking the Difference

We often hear from patients about the extraordinary level of care they receive at NCCC. This is a testament to the very hard work of the entire staff. At a time when a patient needs it the most, we are here to make the difference. Recently we saw a letter from Linda Burroughs, whose letter was mailed to more than 16,000 people along with the most recent edition of Pinnacle Perspectives, a publication of the Office of Gift Planning at Dartmouth-Hitchcock. Her experience as a patient at NCCC "was so life-changing," she wrote, "that I am in the process of making a planned gift to honor my extraordinary doctors and their amazing staffs."

Linda was diagnosed with breast cancer. Her first experience with an NCCC MD was with Steven Poplack, who immediately put her at ease. "Dr. P's easy way was calming, and I found myself saying that with so much cancer in my family, I wouldn't be surprised if the biopsy results were positive. He took my lead and gently said he wouldn't be surprised either," she wrote. After the diagnosis, surgery was scheduled with Kari Rosenkranz, MD. Then cancer was discovered in Linda's other breast. "This very unusual diagnosis was troubling, but we regrouped. Working around some long-scheduled travel plans, surgery was quickly rescheduled to allow for a bilateral partial mastectomy. The procedure was done on a Friday. The following Tuesday, after careful counseling from my surgeon, I left on a three-day trip with friends.

"After the whirlwind was over and I began radiation treatments, I had time to really think about the extraordinary treatment I'd received," Linda continued. "I wondered how many doctors would have gone back to reread a mammogram after a diagnosis was given and surgery scheduled. How many doctors would call with the results the day after every diagnostic procedure, with the caring knowledge that a day is an eternity when you're waiting on results? How many doctors and hospitals would rework a surgery schedule to accommodate a ‘just-for-fun' trip with friends? How many doctors would call just as you're getting on the plane to say that the post-op tests showed excellent prognosis and to wish you a bon voyage? I am so thankful for Dr. P and Dr. Rosenkranz. They are brilliant and skilled physicians, but they also turned out to be compassionate and kind caregivers. And that made all the difference to me."

What is important to point out about this story is that it is not unique. Steve Poplack and Kari Rosencranz are remarkable doctors – and they belong to a staff of remarkable clinicians. It is nice to be reminded, as with Linda Burroughs' letter, that all the long training and hard work our clinicians have put in make tremendous differences in the lives of our patients.

Congratulations to Jane Hatch, Live Well/Work Well Leadership Award Honoree

The medical director of Live Well/Work Well (LWWW) issued this challenge to 13 D-H supervisors, managers and directors in late May, during a ceremony at which LWWW and the office of the CEO conferred leadership awards on them: "It's crucial that you go forth and multiply," said Robert McLellan, MD, MPH, section chief of Occupational & Environmental Medicine at DHMC.

The efforts of exemplary staff members to do just that, from encouraging walking meetings to organizing monthly sessions with LWWW wellness coaches, were recently recognized by D-H, and one of the honorees is NCCC's own Jane Hatch, Administrative Supervisor, NCCC-North in St. Johnsbury, VT. She says she tries to look at each employee "as a whole, both in terms of physical health and emotional health, to support each other and to provide an environment that is a safe place to work."

Jim Weinstein, MD, Dartmouth-Hitchcock CEO, said, "It's important for us to take care of each other, and to take care of ourselves to make us a sustainable health system. If we can't take care of our engines internally, we can't take care of our system and the reason that we're here, to take care of our patients."

"Oncolution" on the move  Onolution logo

Our very first system-wide improvement project team, Operation VOICE, hit the ground running and has spent the past 10 weeks developing a deeper understanding of the front-end hematology/oncology clinic and infusion suite processes.  Now they are recommending targeted process changes for us to pilot, and when successful, ultimately adopt.  These pilots represent opportunities to learn more about what works and what doesn't work in a controlled environment.

The pilot projects include:

  • Reception area layout (trial information desk outside 3K). Timeframe: June 26-29
  • Mini location and capacity (substitute an infusion suite room with two chairs for the current Mini Room to increase capacity). Timeframe: June 12-13
  • Intake process prior to MD appointment. Timeframe: June 19
  • Clinic-to-infusion hand-off (communicate hand-off using an eD-H pre-populated communication order set). Timeframe: June 26
  • Pharmacy notification system (write and submit chemo orders and start the pharmacy chemo prep process as soon as it is known the patient is ready for treatment). Timeframe: June 26-27
  • Missing/incomplete lab orders ("Efficiency Express" support to configure and test lab order entry process. Timeframe: July 16-20

We encourage you to actively participate in trialing these changes.  The success of this System-wide Infusion Improvement Project depends on each of us doing our part to improve our processes.

"oncolution" blog goes LIVE!   Don't be left behind…catch all of the latest updates about the System-wide Improvement Project Teams and other NCCC improvement initiatives on the newly launched oncolution blog at http://blogs.hitchcock.org/oncolution/

"Why and How Working Together Works"

Michael Ward, vice president for cancer operations, has written a thoughtful guest post for Jim Weinstein's "Culture of Caring" blog at the DHMC website. He singles out the Radiation Center of Greater Nashua, a cooperative project of Mary Hitchcock Memorial Hospital, St Joseph Hospital, and Southern New Hampshire Medical Center and which is celebrating its 20th anniversary this year, as a particularly good example of collaboration in health care. "Together we met the needs of a changing community," Michael writes. You can read the full post here.

Under construction iconTranslational Research Building Approved

The Dartmouth Board of Trustees has approved final plans for the Williamson Translational Research Building, to be constructed on the Dartmouth-Hitchcock campus here in Lebanon. This building is a critical component of the Geisel School of Medicine's plan to lift Dartmouth into the top 20 medical schools nationwide by 2020. The facility will house programs concerned with adapting laboratory discoveries for use in patient care, with an emphasis on multi-disciplinary problem solving in areas including neuroscience, cancer, and immunology/infectious diseases, among others.

Dartmouth's plan will require capital investment to enable faculty growth and to promote research, teaching, and enhanced student experiences. These two new buildings, and other strategic projects, will be supported in part by the issuance of $150 million in debt funding.

Button: Dartmouth-Hitchcock Employee Giving Campaign 2012
In Good Company: the 2012 Employee Giving Campaign

"Everyone knows someone with cancer," says Betty Fulton, a financial aid assistant at the Geisel School of Medicine. "Research advances not only through grants from foundations and the government but also through donations. Our donations to the Employee Giving Campaign enable researchers to make significant strides toward a cure."

Supporting cancer research is one of the many reasons Fulton participated in the 2012 Employee Giving Campaign for Dartmouth-Hitchcock and the Geisel School, which runs through June 30.

If you've already made a gift this year, thank you! You're in good company. More than 1,200 employees have made gifts during the fiscal year ending June 30. Their donations are already at work improving lives by advancing research, medical education, and patient care. 

Gifts to The Prouty, the CHaD Half, or any other fund or program at Dartmouth-Hitchcock or the Geisel School count toward the Employee Giving Campaign. Make your gift today.

Questions? Please contact Amy Schrom at 653-0745 or Amy.Schrom@Hitchcock.org

Grand Rounds Now on Hiatus for Summer

Cancer Grand Rounds will resume on Thursday, September 13. See you then.

Upcoming Events of Note
Prouty Logo
July 13-14: The Prouty and Prouty Ultimate

The Prouty Ultimate

Begins Friday July 13, 2012
5:00 a.m. to 8:00 p.m.
Location: Manchester and Hanover, NH

Cyclists love this beautiful and challenging back-to-back century ride from Manchester, N.H., along scenic rural highways into Hanover, NH, the first day, then participants join The Prouty Century Ride on day two. Join the Ultimate fight against cancer!

For more information on how to take part in the Prouty Ultimate, or to sponsor a rider or group, visit the Prouty Ultimate website.

The Prouty

Saturday July 14, 2012
6:30 a.m. to 5:00 p.m.
Location: Hanover, NH

Starting in Hanover, cyclists ride 20, 35, 50, or 100 miles through the gorgeous Upper Connecticut River Valley. Walkers choose a 3K, 5K, or 10K route in either residential or wooded trails (or combine them for an even greater challenge!). And, sculls and sweeps can Row The Prouty! Bring your own boat and row 5, 10, 15, or 20 miles up and back on the Connecticut River.

Visit The Prouty site for more information and to sign up.