Walking into the waiting room for the 5,200-square-foot Lorraine M. LaPilusa Cancer Treatment Center at Bayonne Medical Center is like walking into someone’s living room. It has softer lights that you would find in most doctors’ offices, and a sense of peace that is only enhanced by the smile of the receptionist.
Although the facility had been here since 1992, it reopened in January 2012 with significant upgrades, including a PET/CT [Positron Emission Tomography/Computed Tomography] scanner, as well as some new staff members.
“We have a cracker-jack team,” said Susan Paramonte, BSN, RN, OCN.
The Director of Peninsula Radiation Oncology Services noted that the center tries to coordinate and work with health professionals to find the appropriate treatment for each patient and to follow through. This includes reducing the stress associated with financing and setting appointments.
“We try to make the process as easy as possible,” she said. “We fit each treatment to the patient. We do imaging such as PET/CT and provide up-to-date radiation services. We even have a coordinator who works with the patients to try to ease them through the process for whatever they may need. They may need help with financial services or help with scheduling appointments. Anything we can do to make the process easier.”
The center treats nearly any kind of cancer, but does not treat children.
“We keep to schedule, and when it comes to patients, we try not to let anybody wait and we take our time with each patient,” she said
Part of this is to try to make sure that their transportation is arranged so that when they’re treated, they can get back home as soon as possible or to other appointments, such as chemo therapy, so they are not delayed.
The inner workings
After they are brought into the treatment area, patients go into a room where they change into gowns.
“We have a nurse that assists them in getting changed, and then the patient goes back to the radiation suite,” said Paramonte.
The facility has a holding area that accommodates walk-in patients as well as patients from Bayonne Medical Center. A round desk in the middle of the suite serves as a nurse’s station. One room is reserved as a waiting area for patients who come in for PET scanning.
“They have to be injected with a tracker and so they need to rest in a quiet area for about an hour, where they have access to a TV and a lounger,” she said.
The heart of the center is a small room filled with instruments where two therapists monitor all of the activity, checking reports from each of the machines, and where the planning takes place.
“It’s a very complicated process, but we have very good people involved,” she said.
Molds are made for individual patients so that they stay in one position during the procedure.
Lights change the mood for the patient.
“You can have what color you want, and what music.” she said. “They are not in here for a long time, but whatever time they are in here, we want them to feel good. We have CDs. They can pick whatever they want, but we don’t want them to pick music that will make them want to get up and dance. We really want them to stay still,” she said.
“We can shape the radiation to the shape of the tumor.” – Dr. Anne Kim
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New technology
The new PET scanner replaces a less sophisticated portable scanner, which was previously only available at the hospital once a week. This is a device that produces a three-dimensional image or picture of functional processes in the body, and it is used to detect cancer, determine whether a cancer has spread in the body or whether it has returned after going into remission. It is also used for a number of heart- and brain-related uses.
Using the new PET/CT scanner to pinpoint the extent of cancer, doctors will determine what option is best suited for each patient: surgery, chemotherapy, or radiation.
Called a linear accelerator, the machine can effectively treat cancer areas with little or no damage to unaffected areas of the body, which is part of the latest generation of treatment that uses precision treatment techniques.
“When a patient comes in for a consultation, we meet, evaluate the information, and recommend a treatment plan,” Dr. Anne Kim, the director of radiation oncology. “We customize the treatment to the patient.”
Radiation is an option that depends on cancer.
“In some cases, we give radiation as the main treatment. Sometimes it is integrated with chemo or surgery. It all depends on the type and the state of cancer,” Kim said. “We discuss with the patient the options and the possible risks associated. We work intimately with the patient’s doctors.”
Chemo, she said, tends to be a broad treatment, carried everywhere in a person’s body through the blood. Radiation has the ability to pinpoint an area, especially with the latest technological advances, to do minimal damage to unaffected areas.
“We can shape the radiation to the shape of the tumor,” Kim said.
This is important when the tumor is irregularly shaped, so that radiation can be directed at the tumor and not the tissue around it. Other imagery is used to identify where the tumor is, then shape, then seeing everything that is nearby.
“We designed a plan and then shape it so that it is fine-tuned and at faster rate to what we’re targeting,” she said.
The object is to provide minimal radiation to normal tissue and to minimize the side effects. A patient comes every day come and the center monitors the changes so that the directed radiation is altered as the tumor shrinks.
As with each individual, the treatment is based on specific situation, she said. And there are other issues to be considered, such as possible other medical conditions. A plan often isn’t just about the physical issues, but also social, nutritional and other issues. This unit works with doctors throughout Hudson County and even in Manhattan in the community.
“Wherever their services are, we work with them,” she said. “The ultimate goal is to treat the patient better. We remember that patients are affected all of their lives, and we think of the whole person.”
Defining the problem
Dr. Perry S. Williams, who is one of the key people of the community outreach program, said radiation will attack cancer cells regardless of where they are in their growth cycle. A good example of that is prostate cancer in which a great majority of the cells that are present at a given time are arrested; this is one of the reasons chemo therapy really has no impact on it.
There are really two primary focuses for delivery of radiation, he said.
“You can treat on the machine with a highly directed beam external,” he explained. “You go through the meticulous work of defining all of the normal tissue, critical organs and then you tell your computer I want to give the target this much radiation, based on experience knowing how much radiation is usually effective for a given type of cancer. But you also tell it, I don’t want more than this dose of radiation to these things, and so in the end, it actually takes a little longer to deliver the treatment.”
But with this treatment, there is greater precision and more normal tissue is spared from unnecessary harm.
Formerly the medical director at Clara Maas, Dr. Williams said the Bayonne Medical Center has a strong community presence, providing state-of-the-art treatments to local people.
“I’ve always been interested in bringing cutting edge, state-of-the-art technology to the community level so that you don’t have to invest the time and expense slumping around the country side,” he said. “This is an evolutionary step. There was a full-service department at Christ Hospital, but there was a need to upgrade technology, and there was a department at this hospital for years, and this is the big technological step forward.”
“Another big thing accomplished here is that we’re about to launch our program here in conjunction with the American Cancer Society, which will give us much more profound community outreach and support, such as running of support groups and also offer support for reimbursement for oral medications. Patients might not be able to afford those because their insurance won’t pay for it,” he said.
In essence, he said, the facility is entering into a social contract with the patients.
“We’re not going to take care of the problem and then say, ‘see you later.’ Following up with all the intimately involved services becomes important, because we know there is toxicity from treatment, which can be managed, and there is a lot of post-cancer support,” he said. “Most cancer patients go through a roller coaster experience with problems when they are diagnosed. There are emotions they get swept up in when dealing with it, and then the active treatment is over and they walk out the door and they don’t know what else is there.”