Teamwork

HARTFORD HOSPITAL CANCER PROGRAM

2002 ANNUAL REPORT

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Cover Photo (clockwise from top): Vincent Laudone, MD, Urologist;Gardy Moreau, RTT, Radiation Oncology; Darcie Shewokis, RN-Advanced, Inpatient Oncology;Patricia Defusco, MD, Medical Oncologist; W. Jeffrey Baker, Medical Oncologist

“The way a teamplays as a whole

determinesits success.”

Babe Ruth

Cancer Nursing Team placedfourth in Advance for Nurses2002 Nursing Team of the Year Award.

Cancer ProgramCollaborative Management Team

The Cancer Program values team work in addressing needs of cancer patients and families. We continue toinvolve ourselves with a large number of clinical activities, programs, initiatives, and efforts to optimize the care wedeliver. The patient and family are important members of the “team.”

Multidisciplinary and Interdisciplinary Care continue to be a hallmark of meeting patient needs. Medicalspecialists including surgeons, hematologists, medical oncologists, radiation oncologists, and primary care physicians,as well as many other specialists work together with nurses, nutritionists, pharmacists, chaplains, social workers, andothers to collaboratively optimize care for our patients and families. The Helen & Harry Gray Cancer Center contin-ues to foster this collaborative approach. As a result, satisfaction scores from patients and families for their care areextremely high. We are particularly proud of the numerous support efforts offered to our patients, including CHESS,a web-based program of information and support for women with breast cancer and men with prostate cancer, ournumerous support groups, and other individualized support activities.

Multiple committees are involved at the strategic, advisory, and operational level within Hartford Hospital tohelp oversee and direct Cancer Program activities. The Cancer Committee, chaired by Dr. Vincent Laudone, auditsour clinical activities, monitors Cancer Registry functions, and performs multiple patient care studies annually. TheCancer Program Advisory Committee provides strategic direction within the context of the overall hospital strategicplan. The Core Committee focuses on operational aspects of the Cancer Program and advises the CollaborativeManagement Team on programs, events, initiatives, and clinical issues. The healthcare team continues to overseequality improvement projects designed to improve identified problems or issues with patient care.

Our Cancer Registry continues to be a model of data acquisition and utilization by our researchers. We havereceived a full three-year accreditation from the American College of Surgeons Commission On Cancer in theteaching hospital division, recognizing the excellence of our Cancer Registry and Cancer Program overall. Dr. RobertPiorkowski, our Cancer Liaison Physician for the American College of Surgeons, chairs the Liaison Committee for allof Connecticut and provides an important link to State and National organizations.

Dr. Robert Siegel and Ms. Camille Servodidio provide leadership for our Cancer Clinical Research Office. Wehave involvement with multiple cooperative groups. Under the direction of Dr. Siegel, we participate in studiesthrough Cancer and Acute Leukemia Group B (CALGB). Under the direction of Dr. Patricia DeFusco, we continueto participate in National Surgical Adjuvant Breast & Bowel Project (NSABP) as well as provide coordinating role forConnecticut institutions of the STAR Breast Cancer Prevention Trial. We also participate in Gynecologic OncologyGroup (GOG) research under the direction of Dr. Stacy Nerenstone and Dr. John Nash. The Cancer ClinicalResearch Office also continues to oversee Wisewomen and Scope Grant as well as our Breast and Cervical CancerEarly Detection Project outreach activities to medically underserved women in Connecticut.

Our collaborative relationship with Dana Farber/Partners Cancer Care also brings research, educational, andprogrammatic opportunities to allow Hartford Hospital’s Cancer Program to develop as a continued Center ofExcellence. This important link to an internationally recognized and designed comprehensive cancer center and majorresearch institute will allow us to bring unique translational research to Connecticut cancer patients.

We are so fortunate to have many individuals within the Cancer Program and throughout Hartford Hospitaland its medical staff who embrace the “team” approach and support the notion of first and foremost meeting the needsof our patients with excellence in cancer care, and attention towards how we can support the patient and familythrough their cancer diagnosis and treatment journey. The dedication and enthusiasm of our medical staff, hospitalstaff, and volunteers in making Hartford Hospital an excellent place for our patients and families to receive cancer careis greatly appreciated.

Andrew L. Salner, MD, FACR

Robert E. Rice, MS, DABR, FAAPM

Elizabeth Lada Morse, RN, MPA, MSN

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Cancer NursingIn an era of nursing shortages throughout the country

Hartford Hospital and the Cancer Program continue toattract and retain nurses of the highest caliber. Newlyhired nurses often cite the comprehensive orientation andongoing education as reasons why they choose HartfordHospital as an employer. Each new nurse has a preceptorand orientation is tailored to their learning needs. Tenstaff nurses maintain Oncology Nurse Certification(OCN) and the Clinical Nurse Specialist is AdvancedOncology Nurse Certified (AOCN). This year HartfordHospital was first in the State of Connecticut to offer anOncology Nursing Society (ONS) certified course forChemotherapy and Biotherapy which was offered tointernal and external nurses. Four nurses attended anONS trainer program to be qualified to teach this course.Ongoing staff development was supported throughnumerous educational offerings including attendance atAnnual ONS Congress as well as local and regionalprograms. Staff education regarding end-of-life (EOL)care has been emphasized this year. Nurses and othershave attended monthly education sessions on EOL.Cancer Nursing presented a Nursing ResearchRoundtable focusing on nurses’ comfort with end of lifecare. Nursing, along with the Institute for OutcomesResearch and Evaluation at Hartford Hospital, aredeveloping self-learning modules for nurses interested inEOL. One staff nurse has obtained certification through aHospice and Palliative Care Organization.

Our shared governance model of nursing emphasizesteamwork and accountability for every member of theteam. Through a nursing council structure, staff membershave input on performance improvement, education,practice and resource management including hiring of newstaff. Four Advanced RNs, recognized as clinical leaders,assist in the development of evidence-based practice,mentoring and coaching staff. All staff participate in a peerreview process as part of their annual performance review.

Nurses at Hartford Hospital have been the recipi-ents of several awards this year. Laura Caramanica, RN,PhD, Vice President for Nursing was the recipient ofConnecticut Nurses Association’s (CNA) Doris ArmstrongAward for Excellence in Nursing Administration. Ms. Armstrong,the award namesake and former Vice President of Nursingat Hartford Hospital, administered the award duringCNA’s Diamond Jubilee Award dinner. It is one of thehighest honors a Connecticut nurse can achieve. Advancefor Nurses, a New England regional magazine, awardedHartford Hospital nurses with first and fourth place in its“Nursing Team of the Year” awards with first place goingto Women’s Health and fourth place to Cancer Nursing.

Inpatient care units on Conklin Building 4 (CB4)and Conklin Building 5 (CB5) have been combined underthe leadership of one nurse manager. Staff on these unitsshare resources and routinely work between both units.Weekly multidisciplinary patient care rounds on each unitinclude care coordinators, social workers, chaplains,dieticians, nurses and others. Pharmacists and nursesconduct monthly rounds on each unit to audit for medica-tion safety and compliance. A multidisciplinary Ad HocTeam is credited with creating the new Cancer LearningLibrary on CB5 which features printed and mediainformation for patients and family on aspects of cancercare. A computer with internet access is also available inthe Learning Library.

Hematology Oncology Outpatient Services contin-ues to provide a broad array of chemotherapy, biotherapyand transfusion services. Outpatient education anddevelopment has focused on implementation of Ambula-tory Payment Classification (APC) of services under theOutpatient Prospective Payment System. A team ofclinical, financial and information management represen-tatives meet regularly to review and improve currentprocesses. This year we have implemented a standardizedoutpatient patient satisfaction survey which will allow usto benchmark our results against other similar cancerprograms, both regionally and nationally.

Elizabeth Lada Morse, RN, MPA, MSNDirector of Cancer Nursing

Prostate Cancer Support Group We completed our 11th year of service to prostate

cancer patients and their families throughout Connecticutand parts of Massachusetts. Our Hartford Hospitalsupport group is an affiliate of USTOO!, the internationalprostate cancer support group begun in 1990. We continueto serve as a prototype for such groups throughout thecountry.

Membership has grown to nearly 800 with atten-dance ranging from 62-114, depending on the topic (andthe weather). New people arrive each month, somereferred by their urologists and/or urology nurses, somefrom internet searches, and some with their memberfriends.

During the past year, members kept busy withnumerous activities concerning prostate health and theimportance of early detection of prostate cancer. Theyvolunteered at health fairs in CT to help the publicheighten their awareness of the need for regular medicalcheckups.

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At the Greater Hartford Open (GHO) PGA golftournament this summer, several members manned aprostate health booth sponsored by Hartford Hospital.The focus was on emphasizing the importance of screen-ing and early detection for prostate cancer. Thousandsattended the tournament and stopped by our boothlocated in the main tent. They not only inquired abouthealth, they also spoke about their personal medicalexperiences and praised our endeavors.

A group member did a marvelous job with volunteerrecruitment and worked many long hours behind thescenes with other members to make sure everything wentsmoothly. This was an incredibly successful event. Inaddition to watching the best golfers in the world, hun-dreds were able to obtain vital health information throughthe handouts that were distributed, courtesy of pharma-ceutical representatives. Additionally, Dr. James Graydon,from the Hartford Hospital Department of Urology and agroup member, gave a poignant interview on WTIC-AMtalk news radio 1080 on June 20 with a focus on prostatehealth issues.

The Second Annual “Reluctant Brotherhood” GolfTournament was held at Goodwin Park Golf Course onJune 17. This “fun raiser” event was chaired by two supportgroup members, and brought 40 golfers for a delightfulday of play and friendship. A barbecue picnic followed thegala event. Prizes were awarded for low net, low gross,closest to the pin, and longest drive. There was muchlaughter all over the golf course throughout play! We willwork on recruiting more volunteers for next year to helpus with publicity, favors, registration, etc.

Another member continued as USTOO! interna-tional support group liaison. He distributed informationvia flyers about our upcoming meetings/events tochurches, senior centers, imprint newspapers, churchesand more. His hard work yielded some newcomers whowere not aware of these programs.

The steering committee met twice this year. Oursteering committee members represent group members,physicians, and the support group facilitators. We aredeveloping a questionnaire to ascertain whether or notsome members are interested in providing one to onesupport to those in need. We will also work on streamlin-ing our meetings to become more efficient without losingthe “user friendly” flavor.

The format for the Hartford Hospital ProstateCancer Support Group monthly meetings was a formaleducational presentation including time for questions and

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answers. This was followed by group happenings thatculminated with breakout discussion groups in aninformal setting—a most vital part of each meeting.

Members chose which of the three discussiongroups to attend: treatment issues, ongoing managementconcerns or stress reduction. Between 11–55 peoplestayed for our breakout sessions.

Meeting topics this past year were:

• “Radiation Oncology Alternatives in Managing ProstateCancer,” Andrew Salner, M.D.

• “Holiday Fun!” Pot Luck Supper and entertainmentwith group members and the Sam Pasco Trio

• “Walking With the Unfamiliar,” Evan Fox, M.D.

• Video: “Laughter: Prescription for Survival,”Joyce Anisman Saltman, A.S.

• “Nutrition: Yesterday, Today and Tomorrow!,”Ann Zogbaum, R. D.

• “Update on Hormone Treatment for Prostate Cancer,”Jeffrey Morgenstern, M.D.

• “Ask The Experts,” Andrew Salner, M.D.,R. James Graydon, M.D., Jeffrey Baker, M.D.

• “Panel of survivors and their spouses & 11th Anni-versary Celebration,” with support group members

• “Discussion: Where We’ve Been, Where We’re Going,”with support group members

• “Exercise Is Not a Four Letter Word, It’s a Prescription forLife,” Christine Zielinski and Paul Morse, professionaltrainers from the Newington Wellness Center

• Video: “Personal Experience with Prostate Cancer from aPatient’s and Surgeon’s Perspective,” Peter Deckers, M.D.,Peter Albertson, M.D.

• “What Are Your Health Insurance Choices andRights?,” Sharon Garrard from the North CentralArea Agency on Aging

Group members stepped in to pinch hit for ourgeneral chairman who was on temporary leave. Theywelcomed newcomers and updated everyone on the latestgroup news. This support group has evolved into acommunity of caring and an extended family. It is anhonor to serve as coordinator of the Hartford HospitalProstate Cancer Support Group

Margaret A. Garrison, A.P.R.N., B.C.Support Group Coordinator

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Our goals this coming year includes helping mem-bers to learn new social skills enhancing quality of lifewhile managing on-going issues of family and work stresscommon in this increasingly younger population. Peopleare encouraged to enjoy life while fueling their bodies withhealthy food. Many members had little or no knowledgeabout nutrition prior to their cancer diagnosis.

People who attend for the first time are alwaysmoved by the resolve of this band of brothers whocontinue to come to Hartford Hospital once a month inany weather to encourage themselves and others to surviveprostate cancer.

Carole B.C. Fox, CURNSupport Group Coordinator

Advanced Prostate CancerSupport Group

Describing his approach to recurrent cancer, onemember recently said he intended to “stay in the game,”indicating he would be the first to raise his hand if aclinical trial came along that might even hint at theprospect of a cure. Stay in the game has become the mottoof this monthly group, now in its ninth year.

The average age of the group is sixty. Men as youngas forty-six and as old as eighty-eight join the groupregularly to share their progress, treatment plans, goalsand inspiration with each other.

The round table discussion format worked particu-larly well. A feeling of closeness prevailed as members tookturns talking about their progress. Questions and sugges-tions related to diet, care and exercise were discussedindividually. In addition, members bring in handouts fromthe internet, other cancer centers and urologists fordiscussion and review. Often, when a member was unableto attend due to illness, someone else from the family camein his place to take notes. When someone dies, we talkabout it together. Some members attend services tocomfort the family.

The annual potluck supper was held in December.This is a time of reflection about the year and remem-brance of those who have passed away. Several of ourmembers read their own poems.

There is a growing trend among group members toself-direct their own care. As personal research and accessto internet chat rooms increases, members feel empoweredto discuss sophisticated treatment options with theirphysicians. This measure of self-direction helps people tofeel in control. Education remains a critical factor in theirongoing care.

The format changed significantly over the last yearwith a marked reduction in physician visits as memberstook more ownership of the agenda each month. Weencouraged our members to attend the main supportgroup meeting when topics of interest were presented,such as physician question and answer sessions. Member-ship in the group was steady at around 90, while monthlyattendance ran between 15-25, with or without a speaker.Several men assumed the role of patient advocate for thegroup. Their names and telephone numbers appear on themonthly flyer.

Dr. Vincent Laudone, urologist, came for his annualvisit to discuss new treatment options. In November, CarlSwartz, a human behaviorist will join us. Dr. AndrewSalner, radiation oncologist and Director of the Helen &Harry Gray Cancer Center, will talk with us early in 2003.

Spouse Prostate CancerSupport Group

Hartford Hospital initiated the Spouse ProstateCancer Support Group five years ago in response to agrowing need to support wives of our prostate cancerpatients. Informal dinner meetings are held the secondWednesday of every other month at the Helen & HarryGray Cancer Center. Attendance averages 10-15 women.Two facilitators manage the meetings: Peg Garrison,APRN, from the Department of Psychiatry and CaroleFox, CURN, from the Department of Urology.

The purpose of the group is psychosocial support tohelp women face the uncertainty, emotional, and often,financial turmoil that prostate cancer can bring to afamily.

Meetings center on women’s health, i.e. ways toachieve emotional balance and stay physically well.Handouts about meditation, exercise and diet are givenat each session. Each meeting concludes with a relaxationexercise.

Members express their individual needs for solaceand share feelings and concerns in a confidential, non-judgmental setting. Through roundtable discussions,ideas for managing life’s numerous stresses are offered.Before the women leave, they often exchange phonenumbers in order to support one another betweenmeetings.

The Spouse Prostate Cancer Support Group is yetanother way in which Hartford Hospital addresses theneeds of families.

Margaret A. Garrison, A.P.R.N., B.C.Support Group Coordinator

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CHESS: On-Line Information, Supportand Decision-Making Tools forCancer Patients

Over the past year our patients have greatly enjoyedthe Comprehensive Health Enhancement Support System(CHESS), expressing high satisfaction with the programand also indicating that it enhances satisfaction with theircare. Throughout the past year, 119 women have beenenrolled in “Living After Breast Cancer Diagnosis,” with 25 ofthem borrowing one of our laptop computers. Seventymen have been referred to the “Living with Prostate Cancer”module, with 7 borrowing a laptop. These patients are ableto gather information, share support with others andutilize tools to help with decision-making, in the comfortof their homes, at any time of the day or night. CHESSalso links users to other reliable cancer information websites.

Since CHESS’s introduction at Hartford Hospitalin 1996, we have reached over 640 women with breastcancer and 198 men with prostate cancer. Thanks to ourgenerous donors, we own 56 laptop computers and loanthem to patients who do not own computers; we alsoprovide those patients with free internet access andtraining. In total, we have loaned computers to more than150 men and women using CHESS. Patients with theirown computers are also given free access to CHESS.

“CHESS is a neat way to be able to

sit down, type all those things

you’re feeling, and then throw them

out there where they will be caught

by others who are going through

the same thing.”

Satisfaction with CHESSSince 2000 we have been surveying CHESS Breast

Cancer module users after 3 months in CHESS. Ofthe women returning the surveys, 72.9% indicated thatCHESS exceeded their expectations as a health educa-tion resource tool. The majority of the respondents(79.2%) believe that CHESS exceeded expectations inincreasing breast cancer knowledge. The clarity anddepth of content and its impact on the understanding oftheir illness exceeded expectations for 79.2% of thewomen returning the surveys. CHESS also improvedthe personal coping skills of 75% of the respondents.CHESS helped prepare them for an office visit throughimproved communication, according to 56% of users.

Starting in August this year, CHESS has imple-mented on-line satisfaction surveys for those patientswith an email address. Response has been overwhelm-ingly positive, with higher numbers responding tosurveys in this form.

Breast cancer patients can access the CHESS website anytime, day ornight, in the comfort of their homes.

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CHESS Health Education ConsortiumHartford Hospital, as a member of the CHESS

Health Education Consortium (CHEC), is part of aninternational group of health care providers who are onthe cutting edge of technology use for interactive patienthealth education. The Consortium’s two-day annualmeeting was hosted by Hartford Hospital October, 2002.Nineteen members of the consortium and many membersof the hospital staff were able to enjoy keynote speakers inthe field of e-health and information technology. Themeeting also covered new developments, research findingsand future innovations in the field of computer-basedhealth information systems.

CHESS consortium members are involved in manyresearch projects related to the CHESS modules that existnow or are in development. Those projects include:• A computer-based project for prevention of smoking

relapse.

• Barriers to Implementation of Computer Based HealthSupport Systems (CBHSS). The preliminary resultsfrom this multi-site study show that clinician’s time,resources, role threat and the fact that the technologyrepresents change are the greatest barriers to imple-mentation of a CBHSS. The technology must fit intothe workflow, be easy to use, be high quality, affordable,convenient and easily adaptable. Clinicians must befamiliar with the technology in order for it to beaccepted in the organization. Hartford Hospital is akey participant in this study.

• A Dementia Caregivers module is under developmentat this time.

• In the cancer program, we have looked at Self-DirectedUsage Patterns for women using the breast cancermodule. The majority of the women participating washighly educated, enrolled a month or more after theirdiagnosis and had early invasive disease. Use ofCHESS is highest in the first month, with mostwomen finding that 4-6 months of access met theirneeds for information, decision-making help and socialsupport.

There are also many new developments within theCHESS program. The Breast Cancer module has been re-designed; topics are easier to find and use of the programis more intuitive. A self-learning program has beendeveloped, assuring that patients who cannot receive in-person training are able to navigate CHESS easily. On-line automated registration process, available at FletcherAllen in Vermont and Harvard Pilgrim in Boston, is nowavailable at Hartford Hospital for menopause and heartdisease patients.

CHESS continues to be supported by grants here atHartford Hospital and we continue to be active not onlyin research but also in making this exciting, interactivehealth technology available to our patients. We are proudto be the only health care facility in Connecticut to offerCHESS. You can view a demonstration of a CHESS moduleby visiting the CHESS web site (http://chess.chsra.wisc.edu).

Diane Ward RN, BSN, OCNCHESS Program CoordinatorHartford Hospital Cancer Program

“The nice thing aboutteamwork is that youalways have others onyour side.”

Margaret Carty

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Nutrition ServicesNutrition Services continues to work toward

providing quality care and support to our patients andtheir families. This fiscal year 530 outpatients referralswere realized. Of the patients receiving radiation therapy,93% received a nutritional consult. Referrals increasedfrom Medical Oncology this year as well. A strong effortcontinues between the in-patient dietitian and theoutpatient dietitian to provide seamless patient carebetween the hospitalized and outpatient setting. PatientSatisfaction Surveys were 98% positive for the outpatientdietitian’s services.

Nutrition Services remained supportive of CancerProgram outreach and education programs by co-chairingCelebrate Life!, and The Remembrance Service. Activeinvolvement with the program development committee forthe Mary Mulready Sullivan Symposium and the MarciaReid Marsted book signing was also realized. Octobermarked two informational community outreach programsin Simsbury and Newington for Breast Cancer Month andthe dietitian participated in these. Three Lunch & Learnswere given in collaboration with Community HealthCharities to promote cancer prevention and healthawareness at local businesses this past year.

Four programs were presented for bereaved familymembers at the D’Esopo Resource Center. The topicaddressed was “Taking Care of Self, Managing Your Eating andSleeping While Grieving.” This year the dietitian beganwriting for the Cancer Program News with two articlesentitled “Nutrition Tidbits.” This was a success and futurearticles will be forthcoming.

Nutrition educational sessions for the CancerProgram’s support groups were also accomplished. Thedietitian was guest lecturer for the Prostate SupportGroup and the Breast Cancer Support Group. NewBeginnings, our six-week program for women after breastcancer treatment, had a banner year with each sessionhaving an increased enrollment and retention. In Octoberthis year, New Beginnings was highlighted for “BreastCancer Awareness Month” with Carolyn Pennington onChannel 30.

Ann Zogbaum, MS, RDRegistered Dietitian

Oncology Social ServicesDuring the 2001-2002 fiscal year, our oncology social

workers had over 1300 interventions with cancer patientsand their families receptive to emotional support, educa-tion, information and guidance. The oncology socialworkers continue to assist cancer patients and theirfamilies by providing advocacy, psychosocial support, andresource referrals.

In addition to the Cancer Program direct servicecaseload, the oncology social work team strives to meet theneeds of patients through public outreach. Programs thatthe social work team has been involved with includeHartford Hospital’s Brain Tumor Support Group,Celebrate Life!, the Annual Remembrance Service, and theCancer Program’s Bereavement Committee. In partnershipwith the American Cancer Society the social work teamhas facilitated monthly Look Good, Feel Better workshopsfor our patients. With input from various members of theCancer Program, our oncology social work team has alsofacilitated a comprehensive educational resource center onour inpatient unit on CB5 for patients, family members,and staff. Our oncology social workers are also involved inmultiple task forces designed to assess the needs ofoncology patients as well as collaboration with othermental health practitioners in the community for thepurpose of coordinating resources and strengthening theCancer Program.

Charmain Ali, MSW and Hillary Keller, LCSWOncology Social Work Team

Diana Boehnert, MFA, Integrative Medicine artistteams up with Alice Lavery, RN, OCN,

Hematology-Oncology Outpatient, to create artwork.

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Cancer Center staff and patients. Music and guidedimagery are made available on a weekly basis as well. OnCB4, Chaplains participate in weekly interdisciplinaryrounds, which begin with the reading of the names ofthose who died during the past week in a moment of quietremembrance.

Rev. Kathleen Ogden DavisDirector, Pastoral Services Dept.

Community OutreachThe Cancer Program continues to be active in

community cancer prevention and early detection efforts.Many other partners both inside and outside the Hospitalcollaborate in these efforts. We continue to be a leadingsite for the Center for Disease Control/State of Connecti-cut Department of Public Health Breast and CervicalCancer Early Detection Program. Thus far we haveentered 813 people into this program, including 167 in thepast year. We have detected a total of 21 cancers (4 thispast year) and have provided follow-up services for thesewomen.

In February, the Cancer Program sponsored a specialart exhibit/book signing by two-time cancer survivor,Marcia Reid Marsted. The event featured a display of theartist/writer’s photographs in the Cancer Center Atrium.This exhibit was reviewed by the Hartford Advocate, andone photograph was published on the front page in theMay 16, 2002 issue of the Hartford Advocate. Marcia alsospoke to physicians at a breast pre-treatment conference/tumor board about her experience as a cancer patient.

Pastoral ServicesChaplains offer spiritual care for patients of the

Helen & Harry Gray Cancer Center and their familiesand friends, as well as inpatients from the CB5 and CB4areas. Access to interfaith care and particular faith groupsupport, as well as care of spiritual needs is made availableto the patients and staff of these areas. A resident in theclinical pastoral education program takes primary respon-sibility for meeting the spiritual needs of these areas.Additionally, the staff and other students, as well as theresources of the Pastoral Services Department, areavailable on a 24-hour basis.

Guided imagery, bereavement support, spiritual careand counseling, information about advanced directives,consultation about spiritual and religious needs andpreferences, and direct services are provided. Religiousand/or spiritual care can be a significant means to achievea healing atmosphere. All aspects of the person areinterrelated and nurture of the spiritual self can contributeto positive results affecting the outcome of treatment.

During this past year, the Chaplain resident arrangedfor Jane Heustis, a nurse from Indianapolis with expertisein the use of storytelling, to present to staff and patients atHartford Hospital. She spoke of storytelling as a meansfor expressing emotional and spiritual healing during life’sjourney. Chaplain resident Timothy Gilbert also partici-pated in the dedication of the new Healing Garden at theHelen & Harry Gray Cancer Center. The garden offers avision of hope and life.

Chaplains offer Moments of Meditation as a quietweekly interlude, with music and spiritual renewal for the

The Support Team includes healthcare professionals from IntegrativeMedicine, Pastoral Services,Inpatient and Outpatient Dietary,Pharmacy and Outpatient MedicalOncology.

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Our annual screening efforts this past year were heldin the North end of the city this summer, in which theCancer Program partnered with two area churches in Julyand September. Mammograms, clinical breast examina-tions and training/information on breast self examinationwere provided for screening and awareness of breastcancer. The Cancer Program contracted with a mobileservice to provide mammograms for over 35 women inboth churches. Colorectal fecal occult blood test kits forat-home screening for colorectal cancers in women weredistributed to participants. Men were offered colorectalscreenings during exams for prostate cancer detection.Over 40 blood specimens were collected and processed forPSA levels, another screening tool that is important forearly detection of prostate cancer.

In May, the Cancer Center sponsored five AmericanCancer Society Relay for Life events, and a team represent-ing Hartford Hospital participated in a 24-hour relayevent in West Hartford. Participants, which includedCancer Center staff and patients, literally camped out atthe American School for the Deaf in West Hartford andraised funds and awareness for cancer. One activityincluded a luminaria ceremony to remember/honor thosewith cancer. Members of the team took turns walkingaround the track for a 24-hour period to promote cancerawareness.

The Mary Mulready Sullivan Symposium is a majorCancer Program educational symposium for health careproviders, offered in April of each year. This past year the13th annual symposium focused on thyroid cancer andinnovations in management, and featured five distin-guished speakers, including:

• Richard Robbins, MD, Memorial Sloan-KetteringCancer Center, presented, “Thyroid Cancer: An Overviewof Diagnosis and Management”

• Blake Cady, MD, Women & Infants Hospital, BrownUniversity School of Medicine, presented, “Beyond RiskGroups: A New Look at Differentiated Thyroid Cancer”

• Chaitany Divgi, MD, Memorial Sloan-KetteringCancer Center, presented, “Thyroid Cancer & NuclearMedicine: New Approaches”

• Robert Gagel, MD, MD Anderson Cancer Center,presented, “Medullary Cancer of the Thyroid: A Paradigmfor Managing Hereditary Cancers”

• Rebecca Qualey, RN, BSN, Memorial Sloan-Kettering, presented, “Nursing Issues Related to theThyroid Cancer Patient.”

John Meehan, President and CEO of HartfordHospital, welcomed symposium participants, along withPaul Sullivan, MD and Patricia DeFusco, MD. PaulSullivan, MD, moderated the symposium.

During the summer, the Hartford Hospital CancerProgram sponsored a table at the Canon Greater HartfordOpen. This information table was staffed with volunteersfrom the Cancer Program Prostate Cancer supportgroups, who distributed literature about the importance ofprostate cancer detection.

The Cancer Program participated in the LincolnFutures Golf Tournament, “Chip in for the Cure” in July atBlue Fox Run Golf Course in Avon. The Cancer Programand Partnership for Breast Health also participated in aWomen’s Health Fair sponsored by Hartford Hospital inWest Hartford. Breast cancer detection and awarenessmaterials were distributed at both of these events.

Breast cancer awareness month was kicked offOctober 1, with the Hartford Hospital Healthstar van oncampus at Hartford Hospital. Visitors were offered theopportunity to take a breast health quiz to win a rafflebasket. The annual STAR dinner was held on September30 for 200 participants at the Radisson hotel for all STARparticipants and interested guests. The dinner featuredNSABP speaker Lori Garvey, Director of Public Rela-tions and Communications. High-risk seminars are heldquarterly in conjunction with the Partnership for BreastHealth and the Cancer Clinical Research Office. Dr.Patricia DeFusco presents a timely topic during thesemeetings.

In conjunction with WRCH Lite 100.5 radio station,Hartford Hospital again sponsored this year’s Night of LiteLaughter on October 22. This event was held at theBushnell and attracted a sell-out crowd of 2,500. Therenowned comedian Vicky Lawrence (with Mama)entertained all. The Integrative Therapy “Funny bonesquad” provided pre-show laughs. Information aboutbreast cancer prevention and early detection was distrib-uted to those who attended this event.

Two special community symposiums were held inSimsbury and Newington for breast cancer awareness inOctober. Over 200 people attended the program, “LifeAfter Breast Cancer.” These programs featured informationon eating healthy, knowing genetic risks, Tamoxifen andquality of life, fear of recurrence, and healing through artand journaling.

Susan Wright, MBACancer Program Information Coordinator

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Celebrate Life!June 9, 2002 marked the 12th annual Celebrate Life! event sponsored by the

Helen & Harry Gray Cancer Center. This yearly event attracted over 1,200cancer patients, families, and friends. For the first time, this event was moved offcampus to the nearby newly opened Learning Corridor. This allowed enclosedair-conditioned comfort and protection from the elements. The day’s activitiesincluded food, fun, and the inspiring story of two cancer survivors, one aphysician with Non Hodgkin’s Lymphoma and the other a businessman whowas a two-time breast cancer survivor.

The keynote speaker, Wendy Harpham, MD, is also an author of fourbooks on cancer and was available to sign copies of her books for those inattendance. The theme was “Celebrate Hartford,” and “Mr. & Mrs. Mark Twain”(our oncology nurse educator and her husband) were in attendance to greet andpose for pictures with our many survivors. The Learning Corridor providedmusical entertainment. Over 100 Cancer Program staff and their families joinedin as volunteers for the event. All participants enjoyed the festivities and thechance to celebrate their successes with families, friends, volunteers and staff. Welook forward to next year’s celebration of life.

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The Boutique at the Gray Cancer Center wasformally inaugurated on September 30, 2002. Theproject started two years prior, from a suggestion thatwigs should be available in the Cancer Center. A teamwas formed of Cancer Program staff, including nursesand physicians along with the Hartford HospitalAuxiliary. This team visited the nearest cancer boutiqueat Dana Farber in Boston, and embraced the conceptonce they saw Friends Boutique there. A proposal wassubmitted to the Hartford Hospital Auxiliary, whichapproved and provided a majority of the initial funding.The Auxiliary enthusiastically supported the project,and in a large part helped move the project from thedrawing board to elegantly finished space. Teammembers met with cancer patient support groups fromthe beginning, who encouraged as well as suggesteditems that would be helpful for the Boutique to carry toassist them through their treatment. A registered nursethat already had certification and experience in fittingbreast prosthetics serves as the Boutique Coordinator.The services of a consultant were obtained, who wasinstrumental in opening 15 of these cancer boutiquesthroughout the USA, including Dana Farber FriendsBoutique in Boston.

Funding came largely from the Auxiliary 2001 and2002 Golf Tournaments, and some private benefactors.A team made up of Cancer Center personnel andFacilities Management devoted their time to theBoutique Project. Space was carved out from a storagearea, and an architectural firm designed the Boutique tolook bright and cheery. The space was made to look likepart of the original Cancer Center by integrating features.The Boutique offers hats, wigs, breast prostheses,

sun-protective clothing, lotions, canes, scarves, books,videos and other items to assist patients through thevarious stages of their treatment.

The grand opening on September 30th drew alarge number of Hartford Hospital patients and staff aswell as other interested people who marveled at thetransformed space. The day’s activities also includedvendor product demonstrations, samples, and raffledrawings. In the ensuing weeks, visitors and patientscommented that this was something that had beenneeded for a long time, and were thankful for such awonderful resource. Patients are comfortable in theBoutique, and although a private dressing room isavailable, many feel comfortable taking their headcoverings off to try on different scarves and wigs right infront of the store displays. They also appreciate having achair for their significant other to sit in while they shop.They are grateful that the products they need are in anarea adjacent to where they receive their treatment,saving them energy and precious time avoiding travelingfrom store to store to find head coverings or otherneeded items.

The Boutique at the Gray Cancer Center isunique—the only one in Connecticut with a full timecertified prosthesis fitter on site. The Hartford HospitalCancer Program runs the Boutique. Very specialvolunteers assist the coordinator. It took teamworkbetween Cancer Program staff, the Auxiliary andpatient/staff input to bring this unique Boutique tofruition. The Boutique is a place where healing oftenstarts, and our cancer patients and their healthcareprofessionals truly appreciate this special place.

BoutiqueAT THE GRAY CANCER CENTER

Officiating at the Cancer Center Boutique’s ribbon cutting were (l to r):Hartford Hospital’s President and CEO John Meehan; the boutique’s coordinatorLorraine Casanelli, RN; Cancer Program Director Dr. Andrew Salner; andAuxiliary Co-President Jeanne Conrad.

The

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and physicians on End-of-Life Care issues. The EPECprogram, Educating Physicians on End-of-life Care, wasorganized by Dr. Jim Duffy, Director of ConsultationPsychiatry and Chairman of the steering committee,Connecticut Coalition to Improve End-of-Life Care.

4. The Cancer Program sponsored Nursing Educationpersonnel to be trained as teachers of ELNEC, End-of-Life Nursing Education Consortium, and iscurrently developing a web-based educationalprogram for nursing staff at Hartford Hospital.

5. ICU Millenium, Palliative Care Initiative, directed byDr. Sharon Diamen, Associate Director Departmentof Medicine, reviewed palliative care practice at theend-of-life by collecting data from discipline specificfocus groups and reviewing 40 charts. This informa-tion is now being used as part of the “Best Practices”mission.

6. CB-4 interdisciplinary palliative care team includingDr. Evan Fox, Medical Director of Palliative CareUnit, and others including an Oncology NurseSpecialist, Nurse Educator, Primary nurses, PastoralCare, Social Workers, and Care Coordinatorsdeveloped a presentation to present to each unit inHartford Hospital in an effort to better coordinateand provide palliative care throughout the hospital.

7. The Cancer Program developed and conducted apalliative care volunteer recruitment and educationprogram in partnership with the Volunteer Depart-ment and VNA Healthcare, Inc. The palliative carevolunteer education program is based on NationalHospice and Palliative Care Organization’s volunteertraining standards and resulted in twelve newvolunteers joining the palliative care program. Severalof these volunteers are interested in following the careof patients both in the hospital and at home.

8. Continued collaboration with the Hartford HospitalPain Advisory Committee.

9. To commemorate the lives of many patients’ whohave been treated throughout the Cancer Program,the Cancer Program Bereavement Committeesponsored the sixth Annual Remembrance Service.Family and friends of those who have passed on theprevious year are invited to a service and reception.This year the names of over 500 former patients wereread, which for the first time included names ofoutpatients. Family and friends were invited to bringa memento to display for all to see and appreciate.Each year family members tell us how the cards andnotes sent from the staff and volunteers help themheal and comfort their grief. When we asked themhow we could do better, they respond with, “Keep thecards coming.”

Beth Lada Morse, RN, MPA, MSN and Evan Fox, MD

The Palliative Care ProgramOver the past year, Hartford Hospital has under-

taken many new initiatives to educate and facilitateinterdisciplinary partnerships in palliative care with aprimary goal of “cloaking” patient’s symptoms withcompassionate treatment that promotes patient comfort.Emphasis has been placed on increasing every clinician’sawareness that pain can be physical, psychosocial, spiritual,financial and that many options exist to palliate pain. Weare fortunate at Hartford Hospital to have so manycommitted individuals in all clinical fields that are workingas a team to improve palliative care. Our main goal ofpalliative care is to help all patients and their families,along the continuum of care, to live as vibrant a life aspossible with ongoing attention to reducing symptoms.

2002 Initiatives and Events:1. Florence S. Wald, RN, MN, MS, FAAN, former

Dean of Yale University School of Nursing and oftencredited with establishing Hospice care in the UnitedStates. An internationally recognized speaker, she cameto the Palliative Care Unit sharing her wisdom andhistory of Hospice and her thoughts on how hospiceand palliative care can include the “community” inefforts to improve end-of-life care.

2. Betty Ferrell, RN, PhD, keynote speaker at the SixthAnnual Research/Research Utilization Conferenceheld at Hartford Hospital in October, 2002, is interna-tionally recognized for her research in pain manage-ment and end-of-life care. Following her keynoteaddress, Dr. Ferrell met with staff and volunteers onCB-4, the Palliative Care Unit, for an informaldiscussion on end-of-life care and pain managementissues and left with a challenge for all clinicians toconsider, “each clinician in palliative care must considerthemselves an interdisciplinary team.”

3. Hartford Hospital Ethics Committee sponsored amonthly lecture series focused on educating all staff

Members of the Palliative Care Team.

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The Healing Gardens—Healing by NatureThe Cancer Program hosted the dedication of the gardens at the Helen & Harry Gray Cancer Center,

“Healing by Nature,” on Thursday, June 27. The dedication was led by Chaplain Timothy Gilbert, followed byrefreshments and garden tours. The garden project was conceived by Cancer Center patients, who wantedsomething soothing to view outside while undergoing chemotherapy in treatment rooms. A team wasformed, made up of Cancer Program staff, patients, Integrative Therapy artist and hospital groundskeepers.A design was developed by the group, and staff members took part in planting annuals. A beautiful birdbathsculpted by a local artist was added for a water feature, and the garden also incorporates bird feeders. Variedspecies of birds including Cardinals, visit the birdbath and feeders and entertain the patients while theyundergo chemotherapy in the outpatient areas that overlook the gardens.

TheHealing

Gardens

The Earth is Always With UsEarth, teach us stillness, as the grasses are stilled with lightEarth, teach us suffering, as old stones suffer with memoryEarth, teach us humility, as blossoms are humble with beginningEarth, teach us caring, as the mother who secures her youngEarth, teach us courage, as the tree which stands alone.Earth, teach us limitation, as the ant which crawls on the ground.Earth, teach us freedom, as the eagle which soars in the sky.Earth, teach us regeneration, as the seed which rises in the SpringEarth, teach us to forget ourselves, as melted snow forgets its’ lifeEarth, teach us to remember kindness, as dry fields weep with Rain.The earth is always with usToday, we ask the Great Gardener to bless these gardens.Gardens that burst with bud and bush, flower and tree,Gardens alive with birds, squirrels, and occasionally, a hawkBless these gardens with rain and sunSo that they may growAnd beThe healing gardensThat touch the lives of all who are cared forAnd the caregiversAnd all who look for the healing energyThat gardens can give.Amen.

—Chaplain Timothy Gilbert—Mary Ann Brussart

THE CANCER COMMITTEE REPORTThe Cancer Committee is a multi-disciplinary committee designed to foster the care of cancer patients at

Hartford Hospital. It is responsible for assuring that the hospital, its physicians, programs and registry, meetall applicable national standards for cancer patient care as established by the American College of Surgeons(ACOS).

In 2002, the Cancer Committee acted as a hub for documenting all activities conducted by the variouscomponents of our Cancer Program under the direction of Dr. Andrew Salner, Medical Director. Many reportsin this report highlight the programs and services offered by our team of professionals at Hartford Hospitalthroughout the year.

The Cancer Committee members worked diligently in 2002 to gather documentation and complete allrequirements for the ACOS Commission on Cancer survey held in April. As a result of this effort and that ofmany individuals throughout the institution, Hartford Hospital’s cancer program received an unconditionalthree-year approval.

The important work of the Cancer Committee continued to grow in 2002 as the variety of cancer careprograms expanded. The Breast Cancer Pretreatment Conference was begun, meeting all requirements of theACOS survey requirements. The Cancer Committee physicians continued to perform routine annual qualitychecks of registry data and participated in the development and review of several patient care evaluation studies(PCE’s).

The Cancer Committee will continue its efforts to provide physicians with up-to-date outcome informationto assure that Hartford Hospital remains a leader in comprehensive cancer care.

The goal for the coming year is to meet or exceed standards set by the American College of Surgeons for anapproved cancer program in all areas, as well as implement specific policies and procedures applicable to HartfordHospital’s cancer program needs.

Vincent Laudone, MDCancer Committee Chairperson

ACOS PHYSICIAN LIAISONThe Cancer Liaison Program was developed to serve as a local network of physician representatives for the

American College of Surgeons. They provide direction for establishing, supporting and maintaining cancer programactivities.

The liaison physician at Hartford Hospital serves as facilitator for the Cancer Competition held in November atthe Connecticut Chapter of the American College of Surgeons when residents present papers. He served as Connecti-cut State Chair of the American College of Surgeons Cancer Liaison Program attending the meeting of state chairs.

During the calendar year 2002 at Hartford Hospital, the ACOS liaison physician chaired the weekly Departmentof Surgery Tumor Board, presenting a wide variety of interesting prospective case discussions with excellentmultidisciplinary attendance. The liaison was an active member of the cancer committee, sharing updates on ACOSchanges, assisting in completing the survey application and participating in the annual review of Cancer Registry data.

A representative from the American College of Surgeons Commission on Cancer surveyed Hartford Hospital inApril 2002. Dr. William Chase visited our facility and offered high praise for the dedication and support by theCancer Program staff. The Cancer Program received a full three-year approval with no major deficiencies noted. Wewish to thank all the members of the Cancer Program involved in the survey process.

Members of Hartford Hospital Cancer Program are working together with the American Cancer Society todevelop a Statewide Cancer Control Plan. An institute was initiated in May 2002 at Quincy, Massachusetts to begindeliberations for grants to establish a Cancer Control Plan for the State of Connecticut.

Robert J. Piorkowski, M.D., FACSACOS Liaison Physician State Chairman

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The Partnership for Breast CareThe Partnership for Breast Care, the “virtual” breast

center of Hartford Hospital and its medical specialists,has had an exciting first year. This program is dedicated toproviding seamless care to people with a breast problem byworking with the hospital and the specialists involved inbreast care. The program’s staff consists of a MedicalDirector, Imaging Director, Coordinator and Administra-tive Assistant. The Partnership is proud of its exciting newdatabase and website (www.partnershipforbreastcare.org). Thedatabase is the means of connecting all the different

specialties and services so that the patient and theproviders feel like it is all one system of care. The websitewas created to provide information for people who havebreast problems or breast cancer. The information on thesite was provided by physicians and staff affiliated withthe Partnership for Breast Care. The site was launched inOctober 2002. Our Community Advisory Board, a groupof community members and leaders committed to breasthealth, was formed in January 2002. This group givesdirection to the Partnership for Breast Care on thecommunity and patient needs concerning breast healthand breast cancer. Approximately 400 people wereenrolled in the Partnership for Breast Care in the firstyear. Many more were helped by simply having thePartnership as a resource to ask questions and obtainresources or education.

The Partnership for Breast Care also collaboratedwith other hospital programs to offer communityeducation and outreach. These included: educationalsessions on High Risk for Breast Cancer, and arrangementsfor mobile mammography services at two of Hartford’sinner city churches.

A multidisciplinary weekly pretreatment conference,which is widely attended by those involved in breast care,helps to generate consensus for individual patient issues.

The Partnership will continue to grow over thecoming year with the goals of increasing the number ofpeople served, increasing community education andoutreach, developing a volunteer program to serve thosewith a new breast cancer diagnosis and ensuring a highquality, timely and seamless system of care.

Elizabeth Brady, M.D., Medical DirectorRoxanne P. Rotondaro, MPH, Coordinator

A meeting of the Breast Pretreatment Conference Team.

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Department of RadiologyThe Department of Radiology is comprised of 35

Board Certified Attending Radiologists with specialtytraining and expertise in all aspects of Diagnostic Imagingand Intervention. The Department’s Diagnostic RadiologyResidency program remains fully accredited by the RRCand ACGME, training 18 Radiology Residents.

We continue to provide the most comprehensiveimaging and intervention services in the region with anever-growing role in the diagnosis, care and managementof patients with cancer. The continued advancements incross-sectional imaging and the introduction of functionalimaging have improved our ability to more confidentlydiagnose and monitor disease. Multi-detector ComputedTomography affords rapid highly detailed image acquisi-tion. Advancements in post-processing workstations nowallow two and three-dimensional evaluation. The datafrom these systems is transferred to Radiation Therapyplanning systems allowing highly targeted treatment plansto be developed.

This year we have seen growth in the use of PET(Positron Emission Tomography) Scanning in NuclearMedicine. Because of its reliance on cellular function asthe basis of its imaging, it adds valuable information aboutactivity at the cellular level. This is providing vitally impo-rtant information for the evaluation of disease activity aspatients undergo treatment. We have begun the installa-tion of the first GE combination CT-PET system in NewEngland. This exciting technology will integrate theanatomic details provided by CT imaging with thefunctional evaluation achieved from PET scanning. Webelieve this will have a major impact in cancer diagnosis,staging and therapy monitoring and put HartfordHospital at the forefront of current oncologic imagingtechnology.

In conjunction with Jefferson X-Ray Group, theDepartment has increased its Mammography capacity inthe face of increasing demand and dwindling facilitieselsewhere in the region. We hope to be able to introduceCAD (computer aided diagnosis) technology in thecoming year. In conjunction with the Partnership forBreast Care, we have improved access for patients alongwith expanded educational services for those diagnosedwith Breast Cancer. Stereotactic biopsy procedures andUltrasound-guided Mammotome biopsy services havecontinued to grow. MRI continues to play a growing rolein the evaluation of breast diseases and the Departmentremains enrolled in several national research studiesevaluating its efficacy.

The Division of Interventional Radiology hasexpanded its services with growth in pain managementand tumor therapies. Increasing demand for percutaneousmanagement of tumors has increased the availability andquality of services such as chemoembolization andradiofrequency tumor ablation.

The Department of Radiology remains committedto bringing the finest, most advanced technologies into thehands of the brightest clinicians to support the provisionof the most advanced cancer care available in the region.

Stuart K. Markowitz, MDChairman, Department of Radiology

Pathology and Laboratory MedicineThe Department of Pathology and Laboratory

Medicine is composed of 20 Board Certified Pathologistsand 5 Ph.D. Laboratory Scientists, many of whomreceived their training at major cancer centers includingMemorial Sloan-Kettering Cancer Center and M.D.Anderson Hospital. The department continues to supportan active training program based at Hartford Hospitalwith a total of 23 residents and fellows. During the pastacademic year, Dr. Andrew Ricci sponsored a specialfellow in breast tumor pathology. The Departmentsupports the Cancer Program by co-sponsoring threeweekly Tumor Boards (general oncology, breast oncologyand pediatric oncology). A new Uro-oncology tumorboard meets twice per month.

Members of the Department participate in a varietyof national cancer study groups including the NationalSurgical Adjuvant Breast Project, the GynecologicOncology Group and the Children’s Oncology Group.During the past year, members of the department haveauthored 47 papers in refereed journals, including 15papers on various aspects of cancer. Additionally, 15abstracts were presented at national pathology meetings.

Molecular diagnostics is a rapidly evolving field andthe Molecular Pathology Laboratory is involved inevaluating a variety of procedures for their diagnosticutility. The lab has recently instituted a new DNA basedtechnology known as FISH (fluorescent in-situ hybridiza-tion) for the analysis of both solid tumors and leukemias.FISH allows for the detection of genetic abnormalities atthe chromosomal level while maintaining cell architectureand localization. The initial two targets to be investigatedwith this new method are the HER2 gene in breast cancerand the bcr/abl fusion gene product in chronic myelog-

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enous leukemia. In addition, the laboratory is validatingnew FISH-based assays for the detection of bladdercancer cells in urine cytology, genetic abnormalities inchronic lymphocytic leukemia, and abnormal epidermalgrowth factor receptor genes in both breast and lungtumors.

Using other molecular techniques, the laboratory isinvestigating new markers for the detection of primaryversus metastatic cancers. This is a critical issue in themanagement of lung cancer patients who not infrequentlydevelop a new primary lung mass that needs to be distin-guished from a metastasis. Several markers have beenidentified that have the potential to distinguish a meta-static lesion from a primary tumor and validations in thisarea are currently in progress.

Mark E. Ludwig, MDSection Director, Anatomic Pathology

Integrative MedicineIntegrative Medicine has been very involved over this

past year with the Cancer Program patients. ART forHealing is a very highly acclaimed program in expressivearts, which is directed by Diana Boehnert, MFA. ART forHealing is a program in which anyone can participate,whether novice or accomplished artist. The goals of thisprogram are to assist patients in using art as an expression,a vehicle for self-discovery and healing. Ms. Boehnertworks both individually and in groups with inpatient andoutpatients in the Cancer Program. Diana has conductedseveral community workshops teaching and coachingpatients in the use of expressive Art for Healing. She alsoteaches in the various cancer support groups, which areoffered through the Cancer program. The Patients whohave worked with Diana in these groups and during theiroutpatient treatment have received a great deal of valuableinsight and meaning from this process. We are proud to beable to offer this program to patients.

Integrative Medicine also offers programs in Qi Gongand Tai Chi. Kelly Taylor and Alice Moore are certifiedinstructors who work with patients teaching and guidingthem in these gentle and ancient martial art techniques.Tai Chi involves using slow, graceful, and gradual standingmovements designed to relax the mind and body andstimulate the movement of energy, or Chi, throughout thebody. Qi Gong is a similar discipline, which focuses onparticular techniques, which stimulate energy meridians(similar to the Acupuncture meridians) in a healing way.These gentle movements stimulate healing by removing

energy blockages and encouraging healthy circulation andbreathing. Tai Chi reduces anxiety, improves balance andencourages deep breathing. In this relaxed state, healing isstimulated throughout both mind and body.

Reiki is a hands-on technique, which was developedand perfected thousands of years ago in Japan. It involvestrained practitioners placing their hands over various partsof the body and “sending” or assisting in the balancing ofenergy in the body of the patient. Studies have shown thatpatients have statistically significant reductions in bothpain and anxiety after a Reiki treatment or session, andmany have experienced much more profound healing as aresult of their treatments. Reiki sessions usually lastanywhere from a half hour to an hour. Unlike Massagetherapy, patients are not asked to undress, since the Reikipractitioner simply places their hands over the clothingalong and around particular regions of the body known tohouse the body’s organs and energy “centers.” Patients areable to request Reiki during their outpatient treatment orwhile in the hospital. These sessions are offered free ofcharge and administered by hospital trained and certifiedReiki volunteers. Our Reiki instructor is Alice Moore, RNand Reiki Master.

Massage Therapy, an ancient and time proven therapy,is also offered in the Cancer program. Our massagetherapists are all state licensed hospital employees withspecialties in nursing and various other medical back-grounds and experience. Massage has many benefits tooffer the hospitalized patient including relief from painand anxiety, improved sleep and circulation, enhancedimmune function, and an overall enhanced sense of well-being. We have also measured a reduction in nausea andvomiting after massage treatments in our patients. Thisprogram is widely requested and highly acclaimed here atHartford Hospital.

Integrative Medicine offers a wide variety of compas-sionate and healing services, which complement andenhance ongoing cancer treatment. We are pleased to offerthese as part of our cancer programs.

Molly Punzo, MDDirector of Integrative Therapies,Department of Medicine

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Radiation OncologyHartford Hospital’s Radiation Oncology Depart-

ment focuses on meeting the needs of our patient throughcollaboration with medical staff and hospital colleagues aswell as through the efforts of an interdisciplinary radiationoncology team. We continue to serve as the HUB of amajor radiation oncology network, also providing servicesat UConn Health Center’s John Dempsey Hospital,NRRON (Northeast Regional Radiation OncologyNetwork) sites at John DeQuattro Community CancerCenter at Manchester Hospital and the Phoenix Commu-nity Cancer Center at Johnson Memorial Hospital’sAmbulatory Medical Center in Enfield, Connecticut. Inaddition, Hartford Hospital’s physicists and dosimetristsprovide services at Charlotte Hungerford Hospital inTorrington, Connecticut.

Our interdisciplinary team in radiation oncologyincludes an excellent staff of medical physicists, radiationdosimetrists, engineers, radiation therapists, nurses, socialworkers, dietitians, data management, clerical, and supportstaff.

Hartford Hospital’s department offers a broad rangeof sophisticated radiation oncology services including 3-Dconformal radiation therapy, prostate brachytherapy,intravascular brachytherapy, 3-Dimensional radiationtherapy treatment planning, brachytherapy for multiplesites including gynecologic neoplasms, and sarcomas, CTbased simulation and treatment planning, hyper fraction-ated radiation therapy, systemic radioisotopes in themanagement of bony metastasis disease, and treatment ofa variety of malignant and non-malignant diagnoses. Wehave had considerable experience with intensity modu-lated radiation therapy (IMRT) and will further developthis modality for body neoplasms over the next year.

Radiation Oncologists collaborate with othermedical specialists to develop prospective and ongoingtreatment strategies for our patients. RadiationOncologists participate in a wide array of cancer confer-ences at Hartford Hospital designed to enhance perspec-tive patient management, collaboration amongst special-ties, advancement of interdisciplinary care, development ofindividually tailored cutting-edge treatment protocols,enhancement of our clinical research efforts, and educa-tion of staff, house staff, and students. In collaborationwith the Department of Radiology, we have an active CT-based radiation therapy treatment-planning program,which allows use of radiology’s high-speed CT scannersfor radiation therapy treatment planning. Over this nextyear, CT PET will be similarly utilized for radiationtherapy treatment planning.

The department continues its commitment to clinicalresearch with active participation in studies through Cancerand Acute Leukemia Group B (CALGB), NationalSurgical Breast & Bowel Project (NSABP), GynecologicOncology Group (GOG), and the Children’s OncologyGroup (COG). We are also participating in studiesdeveloped through our collaboration with Dana Farber/Partners Cancer Care.

All departmental staff continues to be active partici-pants in the Radiation Therapy Technology trainingprogram. As one of only 68 sites in the United States, thisprogram has been nationally recognized for training asuperb cadre of radiation therapists for Hartford Hospital,and institutions throughout the Northeast.

In the upcoming year, Hartford Hospital’s RadiationOncology Department looks forward to development ofIMRT applications and the use of CT PET Scanning forradiation therapy planning. We have extensively collabo-rated with members of the Department of Cardiology inthe delivery of Intravascular Brachytherapy (IVBT) for theprevention of restenosis for coronary artery disease. Wehave also collaborated with the Department of Orthopedicsin the management of heterotropic ossification preventionfor patients who have sustained trauma or joint replace-ment surgery. We will continue to explore unique cutting-edge and distinctive treatment management protocols forour patients so that we might continue Hartford Hospital’sstatus as a premier provider of excellent radiation oncologyservices.

Andrew L. Salner, MD, FACR, Medical DirectorRobert E. Rice, MS, DABR, FAAPM. Department Head &Chief Medical Physicist

The General Tumor Board Team meets weekly.

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HematologyThe Hematology Division and Hartford Hospital’s

Helen & Harry Gray Cancer Center maintain activeprograms in cancer research and management. Withretirements and additions of new physicians, therecontinue to be six board certified hematologists inattendance. Hartford Hospital and the Helen & HarryGray Cancer Center Cancer Program continue to providesame day care for hematologic support in red blood cell,platelet, gamma globulin, and iron Dextran infusions. TheHelen & Harry Gray Cancer Center provides the facilityand therapy on a Monday-through-Friday basis. Inaddition, the support staffing of nurses, dietitians,supervisors, and social services provides in-depth completecare for our outpatients’ cancer needs.

With the increased use of bone-stabilizing agents inmetastatic breast cancer and multiple myeloma, we haveseen a significant increase in outpatient infusions ofpamidronate and more recently Zometa in the treatmentof both these diseases, and especially in multiple myeloma.There has also been increasing sophistication in theadministration of outpatient chemotherapy with theadvent of monoclonal chemotherapy protocols includingRituxan, Campath-II and Mylotarg. These treatments areoften attendant by significant initial reactions of thepatients requiring attention of a well-trained staff. TheHematology Section continues to work with the Univer-sity of Connecticut and its teaching and fellowshipprogram in disciplined educational programs.

The cancer program, through the Helen & HarryGray Cancer Center, has developed good patient careliaisons tracking the patient through multiple disciplinesand especially the transition between office, the CancerCenter, and inpatient care.

Lastly, Dr. Steven Firshein has assumed theposition of Chief of Hematology at Hartford Hospital.I look forward to Dr. Firshein’s leadership within thedepartment.

David H. Hild, MDSection Chief, Hematology

Medical OncologyThe Division of Medical Oncology plays a pivotal

role in coordinating patient care, clinical research andmedical education at Hartford Hospital. Our division haseight board-certified medical oncologists as well as asupport staff of more than thirty oncology nurses,secretaries and laboratory technicians. Our inpatient unitis located on CB-5 in close proximity to the HartfordHospital Palliative Care Unit on CB-4. Outpatientchemotherapy treatments are provided at the Helen &Harry Gray Cancer Center as well as at satellite facilitiesin Avon, Windham, and Wethersfield.

Hartford Hospital is fortunate to be able to providestate-of-the-art cancer care through continued participa-tion in multi-institutional clinical trials through theGOG, NSABP, and CALGB. Hartford Hospital’scollaborative program with the Dana Farber CancerCenter in Boston should provide access to additionaldisease-specific research protocols. In no other area ofmedicine does clinical research play a more important rolein patient care than in oncology. Dr. Robert Siegel is thechairman of Hartford Hospital’s Institutional ReviewCommittee and is the medical director of the CancerClinical Research Office.

All members of our division are committed toprovide medical education to medical students, interns,resident physicians, and medical oncology fellows.Educational patient-care conferences are held in conjunc-tion with the Departments of Surgery, Urology, Neurol-ogy, Thoracic Surgery, Gynecology, Pathology andRadiation Therapy. A weekly breast cancer planningconference has been initiated under the direction of Dr.Elizabeth Brady from the Department of Surgery. In 2002we held two symposia, the Mary Sullivan Symposium inthe spring, and are planning the first Annual ThoracicOncology Symposium, which will be held each fall.

As our patient population continues to grow, we planto further increase our division membership. Our majorgoal is to provide the best possible cancer care in theregion and to be a resource for surrounding hospitalsthroughout the Greater Hartford area.

Peter K. Schauer, MD, FACPDivision Chief, Medical Oncology

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Surgical OncologyContributions in the area of Oncology of the

Department of Surgery at Hartford Hospital can beconsidered in two separate ways: the traditional (and stillimportant) statistical information, as well as, individualcontributions by our attending staff in many innovativeareas.

Statistical Information:With respect to this year’s statistics, this year’s cases

are reported first and the numbers in parentheses repre-sent last year’s data. New cases of breast cancer totaled 521(484)* in the past year with 505 (459) operative proceduresperformed; only 84 (89) women underwent total ormodified-radical mastectomy with the majority undergo-ing breast conservation procedures. Sentinel lymph nodemapping to avoid extensive axillary dissection is beingused with increased success and new multi-modalitytechniques are achieving earlier diagnosis of breast cancer.This year, 167 sentinel node biopsies were done and 95additional sentinel and axillary node biopsy combinationswere done as well.

Hartford Hospital evaluated 222 (250) new cases ofcancers of the colon and rectum. One hundred ninety two(214) colorectal operations were performed during thecalendar year. Minimally invasive resectional techniquesare practiced with increasing frequency, and HartfordHospital remains at the forefront with these minimallyinvasive procedures. The institution evaluated 19 newesophageal cancers and performed 5 (7) operations foresophageal cancers – reflecting better staging techniquesto limit operations in those who would not benefit fromsurgery. Thirty-eight (42) new cases of gastric cancerswere evaluated, of which 24 (21) patients underwentsurgical procedures. One hundred and three (94) newcases of cancers of the head and neck region were operatedon at Hartford Hospital, 46 (35) of these were thyroidcancer. A collaborative multi-disciplinary approach to thediagnosis of head and neck malignancies continues andthis institution evaluated approximately 57 (42) cases ofcancer of the oral cavity and pharynx (including a range ofhead and neck malignancies: lip, tongue, mouth, pharynx.)

Hartford Hospital physicians saw 260 (256) cases oflung cancer in the past year, 74 (84) of these cases under-went surgical resection. Again, more accurate staging ofunresectable or incurable disease seems to have dimin-ished both the number of referrals and the number whoundergo operations. Finally, 43 (50) new cases of pancre-atic cancer were evaluated in the past year; 12 underwentsurgical procedures.

MRI, CT, endoluminal ultrasound, laparoscopy andother diagnostic modalities enable better selection ofpatients, eliminating those, who in the past, would haveundergone surgical exploration but could not have had aresection for cure. In areas with very poor survivalstatistics, such as esophagus, pancreas, lung and some GItumors, though overall number of operations may bedecreased, the improved selection process gives more ofthe remaining a realistic hope of cure.

In all, 1,177 operations for cancer or cancer diagnosis(sentinel node biopsies, etc.) were performed this year.

Initiatives of Attending Staff• Partnership for Breast Care

The Partnership for Breast Care is a collaborativeeffort between Hartford Hospital and its affiliatedproviders to bring a more coordinated approach tobreast disease prevention and treatment. While thePartnership for Breast Care is not a provider of healthcare services, it will facilitate the coordination of carefor the purpose of improving access to care and theoverall quality of treatment. The Department ofSurgery faculty members are actively involved inpromoting and contributing to this initiative, startingwith Dr. Elizabeth Brady’s position as Director.

The services are available to any individual seeking carecoordination, information and support as it relates tobreast disease prevention and treatment. If breastdisease is suspected or identified, The Partnership willassist in coordinating care, improving access to care,and reducing the waiting time between detection andtreatment. These services are free of charge. If treat-ment options are limited due to financial circum-stances, the Partnership for Breast Care will assist incontacting programs, which may offer financialassistance.

It is committed to education of health care providersand patients. The Partnership for Breast Care holds aweekly multidisciplinary breast cancer conferencewhere breast cancer cases are presented. The goals ofthe conferences are to provide a multidisciplinaryforum for discussion of breast cancer cases. ThePartnership’s weekly breast conference also qualifies forone hour of CME credit.

A unique feature of the program is the patient infor-mation database. This database will make the systemseamless for patients and facilitate communicationamong the providers involved in patient care. Thedatabase is anticipated to go live in November. Thenew website www.partnershipforbreastcare.org became‘live’ in October

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*Past year in parenthesis

The DOS has begun the process of integrating theBrownstone surgical breast clinic into the Partnershipfor Breast Care (PBC), a hospital wide initiative tointegrate all aspects of breast care, i.e. radiology,pathology, oncology, radiation, and support services.Office based ultrasound will be added to the armamen-tarium of clinical tools in the near future thanks tofunding available through the PBC. Many of the fulltime and private attendings (including Drs. JudithPepe, Anatole Besman and Thomas Banever) havebeen active participants in the protocol committee andbeen faithful attendees and participants in the weeklypre treatment breast cancer conference of conducted bythe Partnership leader, Dr. Elizabeth Brady.

New Initiatives• Sentinel Node Biopsy

Within the past year, Dr. Kenneth Kern has published6 articles on a new method of sentinel node biopsy,which has been adopted by the Department of Surgeryat Hartford Hospital, and in many other institutionsacross the country. Based upon his clinical work atHartford Hospital, Dr. Kern has been invited topresent his technique at the annual meeting of theAmerican College of Surgeons in October 2002. Hewill lecture at the American College of Surgeons post-graduate course on breast disease to an audience of300-400 surgeons.

• Liver Resection

Dr. Rocco Orlando reports that laparoscopic liverresection and cryoablation are new initiatives. He andMark Antonetti, a graduating chief resident, reportedtheir experience with Hand Assisted LaparoscopicLiver Surgery in April, 2002, Archive of Surgery. Theyhave one of the larger experiences with laparoscopicliver surgery for tumor in the country.

Joseph M. Civetta, MDAssociate Director, Department of Surgery

Gynecologic OncologyPhysicians from the Division of Gynecologic

Oncology collaborate with medical oncologists, radiationoncologists and other cancer specialists in planning andproviding comprehensive care for patients with gyneco-logic cancer and their families. In addition, the Divisionoffers community gynecologists assistance with themanagement of patients with pre-cancerous cervical,vaginal, or vulvar disease, and complex pelvic surgery.Finally, consultations from physicians caring for patientswith non-gynecologic cancers regarding their gynecologyneeds are welcomed.

Hereditary Cancer ProgramThe family history should not be overlooked when

planning the treatment and management of a patient withcancer. Medical genetics is an important part of the CancerCenter team. Approximately 5-10% of all breast, ovarian andcolon cancer is hereditary. Significant hereditary characteris-tics include cancer under the age of 50; bilateral cancers ormultiple primaries in the same individual; associated cancerssuch as breast and ovarian, or colon and uterine cancer; andmultiple affected family members in multiple generations.Ethnic background may be important as well. Individuals inthe Ashkenazi Jewish population, for example, have asomewhat higher chance of hereditary breast and ovariancancer. Both the maternal and paternal family histories arerelevant.

Families with a suggestive hereditary pattern may havea changed gene (or mutation) as the cause of the cancer. In50% to 70% of hereditary breast and ovarian cancer patients,mutations may be found in one of two cancer susceptibilitygenes, BRCA1 or BRCA2. Hereditary nonpolyposis colorectalcancer may be associated with changes in the genes MLH1,

The gynecologic oncology division continues to offerpatients the opportunity to participate in clinical trialsoffered by the gynecologic oncology group, the onlycooperative group dedicated exclusively to the study andtreatment of women with gynecologic cancers. In addition,clinical trials involving immunologic treatment strategiesfor ovarian and cervical cancer are available.

John D. Nash, M.D.Director, Gynecologic Oncology

The Gynecologic Team includes (l to r) John Nash, MD, DoreenBowtruczyk, RN, Christina Lavallee, Patient Administrative Associate,and Timothy Boyd, MD.

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Neurologic OncologyNeuro Oncology provides comprehensive services to

patients with tumors of the brain and for cancer patientswith neurologic symptoms. Patients with systemic cancerare assisted with pain management, and diagnosis andtreatment of different neurologic problems related tocancer and its management. The brain tumor managementteam is comprised of physicians from Neurosurgery,Radiation Oncology, Medical Oncology and NeuroOncology and Social workers to help with the complexneeds of these patients. Additional help with coping isprovided by our Brain Tumor Support Group.

Dr. Alexandra Flowers, the only trained NeuroOncologist in Connecticut, sees over 100 patients withprimary brain tumors per year, and also patients withmetastatic disease. She has set up new treatment protocolsfor patients with newly diagnosed and recurrent malig-nant gliomas. Dr. Flowers is board certified in Neurology,with Neuro Oncology training at the M.D. AndersonCancer Center in Houston.

Alexandra Flowers, MDNeuro Oncology

MSH2, or MSH6 (as well as other less common suscepti-bility genes). Examining the patient’s genetic code, orDNA, may identify these genetic changes.

For example, if a patient with unilateral breast cancerand a strong family history is found to carry a mutation inBRCA1, she then has a 40-60% lifetime risk for a secondprimary breast cancer, and a 20-40% lifetime risk forovarian cancer. These increased risks require a reorganiza-tion of the lifetime management plan and may includeheightened surveillance (i.e. mammography, vaginal probeultrasound), chemoprevention (Tamoxifen) and/or riskreducing surgery. There is also a 50% chance that thegenetic mutation will be passed on to each of the patient’schildren. Although there are no childhood cancersassociated with BRCA1 or BRCA2 mutations, unaffectedwomen who carry a mutation are enabled to seek earlysurveillance and preventative treatment.

Genetic counseling with the Hereditary CancerProgram is available to those persons with cancer and/orother extended family members. The consultation consistsof reviewing a detailed family history, discussing theprinciples of hereditary cancer, and an individual riskassessment for a hereditary cancer syndrome. Patientsconsidering testing receive information regarding the risks,benefits, and limitations of genetic analysis. Participationin available research protocols is also encouraged.

The information obtained about a patient’s personalDNA status is held private and confidential. Over 600insurance companies nationwide now pay for both theconsultation and laboratory testing, usually if the heredi-tary risk is greater than 10%. We also have DNA bankingprogram that allows patients to store their DNA forpossible future testing.

The Hereditary Cancer Program of the Division ofHuman Genetics, University of Connecticut HealthCenter, has been serving the patients, physicians, nursesand other health professionals of the Helen & Harry GrayCancer Center since 1992. To contact the Program forfurther information or appointments, please call

Jennifer Stroop, M.S., at 860-679-8848, or by email:stroop@uchc.edu.

Jennifer Stroop, MS, Certified Genetic Counselor

Robert Greenstein, MDDirector of Hereditary Cancer Program of the Division of Human GeneticsUniversity of Connecticut Health Center

Orthopedic OncologyThe Orthopedic Oncology division of the Depart-

ment of Orthopedic Surgery represents a dedicatedregional center with a multidisciplinary team, whichoffers expertise in the treatment of benign and malig-nant tumors of bone and soft tissue, metabolic bonediseases, and metastatic disease of the musculoskeletalsystem. One of only two such centers in Connecticutand six in New England, the Orthopedic Oncologyservice combines the expertise of Hartford Hospital,Connecticut Children’s Medical Center, and theUniversity of Connecticut Health Center.

Three hundred and seven new patients were seenover the past year; 217 operative procedures wereperformed.

Improvements in reconstruction techniques forlimb salvage continue. We are continuing to use bothcadaveric bone/soft tissue transplantation as well asmega-prostheses for reconstruction.

Current active research includes investigating therole of fibroblast growth factor in osteosarcoma incollaboration with investigators at the University ofConnecticut, as well as ongoing research involving newtechnology for limb salvage reconstruction.

Robert H. Quinn, MDOrthopedic Oncology

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Psycho-Oncology Support ServicesThe philosophy of the psychosocial support program

is to meet the needs of cancer patients and their familieswho are confronting any aspect of the diagnosis. Thisfocus encompasses any issues along the continuum of carefrom new diagnosis to end of life. In an attempt to meetthese needs in an organized and systematic manner, ouraccomplishments for the past year have included:

1. A survey of cancer patients and families to evaluatesupport groups offered by the Hartford HospitalCancer Program. This survey helped us to plan andstructure our programs over the past year.

2. Established an informal link with The Dana FarberCancer Institute to collaborate with their team toexchange ideas.

3. Provided a method for all staff to cope with thestressors of providing care to those with cancer. Thiswas achieved with the support of the ChaplaincyDepartment through Moments of Meditation, aweekly offering for all areas of the Cancer Program.

4. Organized efforts to provide support and educationthrough a central mechanism that allows for costeffective, meaningful and coordinated events. Thepsychosocial support team met monthly to determineneeds for programs, methods to improve psychosocialsupport and short term and long term planning for anorganized program.

5. Collaborated with consultation liaison psychiatristwho consulted on over 189 cancer inpatients alongwith outpatient follow up.

6. Coordinated and initiated opening of The LearningLibrary on CB5.

GOALS for 2002/2003:

1. Develop and improvise methods for patients andfamilies to learn about and gain access to supportprograms.

2. Begin to develop options for support for patients,families and staff that include:

• Support groups

• Individual supportive services for patients andfamilies

• Other resources for cancer patients and familiesthat reach into the community

• A seamless mechanism for staff to refer patientsand families for psychosocial support

3. Provide education and team building efforts todevelop necessary skills for all professionals to offerand refer to appropriate supportive services.

4. Pilot an educational/supportive group for all diag-noses and evaluate the program.

5. Pilot a phone number for patients/families/staff whoneed to refer patients for support that is non-emergent.

6. Provide basic interdisciplinary family assessments onall patients/families admitted to CB-4 within 72hours of admission.

Evan Fox, MDPsycho-OncologistDivision of Consultative Psychiatry,Department of PsychiatryMedical Director, Palliative Care Program

Marcia Caruso-Bergman, RN, MSN, AOCNPatient Care Coordinator

Pain Management—PharmacyThe Pharmacy Pain Control Service at Hartford

Hospital has been very busy this past year. We saw 832patients for pain relief or symptom control such asnausea and vomiting. The majority of these patientswere inpatients, however, we did see outpatients in bothRadiation-Oncology and Hematology-OncologyServices. During this year we also provided in-serviceeducation to physician and mid-level practioner staffduring noon conferences and to nurses from manydifferent areas of the hospital and community. We havehad medical students and medical residents from theUniversity of Connecticut School of Medicine roundingout the service. Due to the importance of patient paincontrol, the hospital has established a new medical staffcommittee, Pain Management Committee. The commit-tee chair is Witold Waberski, MD, from the Departmentof Anesthesia. During the next year we hope to furtherenhance our pain management service with the help ofthis new committee.

Richard Gannon, Pharm. D.Department of Pharmacy Services

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Pain Management: AnesthesiaThe Anesthesia Pain Service consults each year on a

number of oncology patients with difficult pain problems.The role of the service has primarily been one of caring forpatients who have required implantable delivery systems toprovide analgesics directly to the neuraxis (into the spinalcanal or epidural space). These patients have failed toachieve adequate analgesia or may suffer unacceptable sideeffects from simpler pain control regimens. Patients,whose pain is inadequately controlled with oral narcotics,can be cared for at home with visiting nurse assistanceeven though a narcotic or local anesthetic is being continu-ally delivered into the spinal canal. The Anesthesia PainService and the home health care agency maintain contactwith the patient and monitor the effectiveness of theimplanted delivery system so that the patient can be asindependent as possible.

The Palliative Care Unit on CB4 plays a critical rolewhenever a patient needs more services than can beprovided at home. State of Connecticut regulationscovering the scope of nursing practice preclude caring forpatients with spinal or epidural catheters in a nursinghome. The Palliative Care Unit is then a valuable resourcefor these patients with pain and other needs. It is hopedthat regulatory changes can be made to allow for moreflexibility in placement of patients with spinal deliverysystems.

Other interventional procedures include neurolyticblocks (involving permanent destruction of a nerve) suchas a celiac plexus block, and a variety of simpler techniques(such as epidural steroid injections) that are used com-monly in patients with benign chronic pain. The Anesthe-sia Pain Service is always available as a resource when itsservices are needed.

Jeffrey Morrow, MDAnesthesia Pain Service

Urologic Oncology Update 2002Prostate cancer remains the most common male

malignancy seen in the United States and continues to bethe major focus of Urologic Oncology care at HartfordHospital. New developments in the area of surgicaltherapy for prostate cancer involve extension oflaporascopic surgical techniques into area of prostateremoval. During the past year, Hartford Hospital hashosted two visiting professors, Dr. Joseph Wagner fromBeth Israel Hospital and Dr. Eric Wallen from theDartmouth Medical Center, both specializing inlaparoscopic radical prostate surgery. An active effort isalso underway to acquire the “DaVinci Robot.” This devicehas the potential to become the surgical instrument of thefuture for performance of this, as well as, other operations.The robot’s exceeding fine and exceptionally precisemovements are controlled by a surgeon via a three-dimensional, computer enhanced, guidance system.Ultimately, these technical advances should result in abetter operation with less patient discomfort and short-ened hospital stays, as well as improved preservation ofurinary and sexual function. Hartford Hospital hopes tomaintain its leadership role in this area of surgical ad-vancement.

Over the past year, the members of the Departmentof Urology have participated in a weekly interactivevideoconference program on urologic cancer sponsored byMemorial Sloan Cancer Center in New York. This liveteleconference is a state of the art, comprehensive reviewof all current issues in Urologic Oncology.

Hartford Hospital remains the premiere center forhand assisted laparoscopic kidney surgery with the world’ssingle largest series of successfully treated patients. Thetechnique, as developed by Dr. Steven Shichman, is taughtto physicians from around the country at courses con-ducted by Drs. Shichman and Tarantino here at HartfordHospital.

Vincent Laudone, MDDepartment of Urology

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Fund DevelopmentMany essential components of Hartford Hospital’s

Cancer Program rely on generously donated funds, whichallow us to maintain unique and distinctive services forour patients and families and the community we serve.Examples of those programs heavily supported by donatedfunds include: participation in cancer prevention researchand cancer treatment research, the breast and cervicalcancer early detection program for underserved women;outreach programs for patients, families, and the public;the acquisition of certain new technologies in RadiationOncology; the acquisition of art and music for the Helen& Harry Gray Cancer Center, the availability of refresh-ments for patients and families at the Helen & HarryGray Cancer Center; the presence of books, audios, andon-line services for patients and families at the PatientResource Centers in the Helen & Harry Gray CancerCenter and on the Medical Oncology unit on ConklinBuilding 5; and the unique CHESS program for patientsnewly diagnosed with breast and prostate cancer to namebut a few. We greatly appreciate the generosity of thosedonors whose contributions make a big difference in ourability to provide these unique programs. The followingfunds help in making many of these programs possible:

The Helen & Harry Gray Cancer Center Fund —This fund makes possible many of the amenities forpatients and families within the Helen & Harry GrayCancer Center as well as many of our outreach programsfor patients, families, and the public we serve. This fund isalso utilized to help support breast cancer research andother types of cooperative group clinical research pro-grams.

The Cancer Patient & Family Assistance Fund—On a selected basis related to need, Cancer Program socialworkers will help identify needy patients and families forwhom a limited financial gift to help with a life necessitysuch as a heating or electric bill may make a world ofdifference.

Heublein Fund—This fund helps make availableaccess to educational opportunities for Cancer Programstaff. This allows nurses, dietitians, pharmacists, physi-cians, and others to travel to meetings or educationalopportunities, which will help to bring new skills to ourpatients here at Hartford Hospital.

Radiation Therapy & Oncology Fund—This fundhelps make possible acquisition of equipment or commu-nications instruments for our Cancer Center programs.

CHESS Fund—This fund helps make possibleCHESS (Comprehensive Health & Enhanced Supportprogram) for our patients.

Mary Mulready Sullivan Oncology Fund—Thisfund helps makes possible our annual Mary MulreadySullivan Oncology Symposium, widely attended bynurses, physicians, and other healthcare providers fromConnecticut and surrounding states.

Palliative Care Initiative/Education Fund—Thisfund helps make possible our palliative care programactivities including acquisition of art and special amenitieson Conklin Building 4, palliative care volunteer recruit-ment and development, community outreach and educa-tion related to palliative care.

Edith Taylor Fund—This fund helps make possibleamenities for patients and families at the Helen & HarryGray Cancer Center.

Winkler Fund—A generous donation by theWinkler family given for the education and developmentof oncology nurses. Nurses have been able to attend localand national Oncology Nursing Society conferences andother educational opportunities. This fund has alsosupported nurses obtaining oncology nurse certification.

Reverend James R. Blanning Fund—Through thefunds donated in memory of Reverend Blanning nursingstaff have been able to attend educational programs relatedto Palliative Care and End-of-Life.

Anyone interested in learning more about CancerProgram funds and giving opportunities should contactCancer Program Administration at 860.545.2390 or FundDevelopment 860.545.2162

Andrew Salner, MD, FACRDirector, Cancer Program

Carol S. GarlickVice President, Philanthropy

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Cancer Clinical Research OfficeThe Cancer Clinical Research Office (CCRO) is an

active participant in a variety of national cooperative groupresearch studies and has expanded its involvement inindustry-supported trials. The office affiliation with DanaFarber Partners/Cancer Care has provided the CCROwith the opportunity to open additional cancer clinicaltrials. The CCRO supports multiple protocols sponsoredby the Cancer and Leukemia Group B (CALGB), theGynecologic Oncology Group (GOG), and the NationalSurgical Adjuvant Breast and Bowel Project (NSABP).For the third consecutive year in a row, Hartford Hospital’sCCRO network received special recognition for theirstellar recruitment efforts at the June 2002 NSABPAnnual Meeting. The NSABP “STAR” trial has beenenrolling patients over the past three years. This study,opened in 1999, compares tamoxifen versus raloxifene asbreast cancer chemoprotectants in high-risk postmeno-pausal women. Dr. Patricia DeFusco heads this researcheffort, and Hartford Hospital serves as the coordinatinginstitution for a network of ten hospitals in the stateinvolved in this study. The Hartford Hospital STARNetwork is currently ranked tenth in the nation. It isanticipated that the “STAR” trial will be open enrollmentfor approximately five years and will enroll nearly 22,000participants. The STAR Community Outreach Program

The Cancer Clinical Research Teamis composed of oncology RN’s,outreach workers and the CancerClinical Research Medical Director.

“Talent wins games, butteamwork and intelligencewin championships.”

Michael Jordan

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for Education (SCOPE) grant has been renewed to theCCRO. The SCOPE grant supports the salary for anoutreach educator who is responsible for recruitment ofminority women for the STAR trial. Co-STAR, anancillary study to the STAR trial is currently open tonewly enrolled women over 65 years old to determinecognitive effects of Tamoxifen versus Raloxifene.

The GOG trials have been doing well with recruit-ment for chemotherapy treatment protocols for ovariancancer under the guidance of the principal investigator,Dr. Stacy Nerenstone. Agents such as Topotecan, Doxil,and Gemzar are now being used as front line chemo-therapy drugs to treat women with the hope of extendingtheir lifespan. An industry clinical trial sponsored byParexel will compare standard chemotherapy with andwithout an Actimmune (interferon gamma-1b) injectionto determine whether the addition injection will affect theoverall survival of women. Dr. John Nash is the principalinvestigator for this trial.

Over the past year, the CCRO has opened severalnew protocols. A Dana Farber/Pharmacia trial comparingexemestane versus anastrozole is open for post-meno-pausal women with metastatic breast disease (liver, lung,deep nodes). A Dana Farber trial will soon enroll patientsfor second line treatment for non-small lung cancer andwill compare immediate versus delayed treatment withdocetaxel after gemcitabine plus carboplatin. A CALGBtrial currently recruiting patients will determine ifselenium tablets can prevent lung cancer from recurring inpeople with early stage surgically removed non-small celllung cancer. An additional CALGB trial will addresstreatment for first line metastatic breast cancer, whichcompares one versus three hours of chemotherapy drug,Taxol plus or minus Herceptin, a monoclonal antibody. Ametastatic phase II breast cancer trial for second linetreatment recently opened which uses gemcitabine andcapectibine (a tablet form of chemotherapy) for treatmentto determine if the combination of drugs can give anadded affect for tumor response.

Finally, the best “treatment” for cancer is to eitherprevent it or detect it early. Since 1995, the CCRO hasbeen involved in the Connecticut Breast & CervicalCancer Early Detection Program (CBCCEDP), a state

sponsored outreach program that provides mammogramsand cervical cancer screening to the underserved andunderinsured women of the greater Hartford area. Theseoutreach efforts are funded by the Centers for DiseaseControl and Prevention (CDC) and organized by theState of Connecticut Department of Health. Twenty-onecancers have been detected since this program began. TheCCRO continues in its second year with the CDC fundedWisewoman, which measures weight, blood pressure, andcholesterol and blood glucose screenings in women, aged50 to 64 who are already enrolled in the CBCCEDP.Interventions such as exercise programs and nutritioncounseling have been implemented through theWisewoman Program.

These are intriguing times in cancer research andtreatment. The CCRO remains committed to makingnovel therapies, screening and prevention strategiesavailable to our staff and their patients.

Camille Servodidio, RN, MPH, CRNO, CoordinatorRobert Siegel, MD, Medical Director, Cancer Clinical Research

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Guiding Principles

Patient care occurs across a continuum which is integrated,coordinated and seamless and is supported by aneffective operational structure, embracing a collaborativeteam approach.

A “user-friendly” environment enhances accessibility andavailability of cancer care.

The Cancer Program is a regional leader in meetingcommunity and cancer patient needs by providing flexible,innovative, and distinctive programs.

Educated consumers are better prepared to become partnersin the determination and delivery of their own care.

Caregivers create an environment that is respectful andcaring and encourage patients to become partners in thedetermination of their own care.

The Cancer Program strives to continuously enhance ourcancer care market position by strengthening our programand building collaborative relationships based on definedpatient needs.

The Cancer Program fosters an environment where decisionsare based on outcome measures and continuous qualityimprovement.

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“Alone we can do so little; together wecan do so much.”

Helen Keller

Healing Garden team members,patients, Hartford Hospital andHelen & Harry Gray Cancer Centeradministration and staff gather forgarden dedication.

The Helen & Harry Gray Cancer Center80 Seymour Street P.O. Box 5037

Hartford, CT 06102-5037(860) 545-3790

www.harthosp.org/cancer/