A Comprehensive Approach to Cancer Care TCSC-Methodist's Cancer Program at a Glance Methodist Medical Center's cancer program holds the American College of Surgeons Commission on Cancer's highest level of accreditation for a non-teaching hospital. The program is comprehensive, with inpatient and outpatient components. The 301-bed regional medical center, located in central east Tennessee, opened as a small, barracks-type Army hospital during World War. It was a pioneer in the field of nuclear medicine and now houses a 40-bed dedicated cancer inpatient unit. Thompson Cancer Survival Center at Methodist, a 17,500 square foot, freestanding facility, is located on the medical center's campus. It opened in 1995 and uses advanced treatment capabilities such as high dose rate brachytherapy for lung and gynecological cancers. Methodist's Comfort CareTrax(SM) program, created by an interdisciplinary team for the care of terminally ill cancer patients, was named a "best practice" by the Healthcare Advisory Board in Washington, D.C. in March 2000. All of the medical and radiation oncologists who practice at Methodist are board certified. A white garden gate swings open. On your right, a lovely waterfall cascades into a tranquil pool, and trees, birds, deer and raccoons seem to surround you. As you move forward, a beautiful backyard garden unfolds, framed by the Cumberland Mountains in the distance. These scenes of tranquil beauty greet patients who receive treatment at Thompson Cancer Survival Center at Methodist in Oak Ridge, Tennessee. A former patient's family commissioned a local artist to paint the murals throughout the cancer center. The idea was to create an indoor "garden" that honored the former patient, an avid gardener, and provided a soothing environment for current patients. Patients' comments indicate that the murals have been successful. "It's just a real calming atmosphere," one patient said. "The murals make me feel like the cancer center cares about what I'm going through. It's like they want to help me as much as they can, and that makes me feel special." While the murals are the most visible sign of Methodist's commitment to patient care, that commitment goes much deeper than physical appearance. Comprehensive Services Thompson Cancer Survival Center at Methodist is the outpatient component of a comprehensive cancer program at Methodist Medical Center of Oak Ridge, which is a not-for-profit facility. Through the inpatient-outpatient program, cancer patients have access to: Some of the latest advances in treatments and technology Nationally recognized disease management program A formal pain management program Clinical trials A wide range of support services Advanced Treatments: High Dose Rate (HDR) Brachytherapy Methodist's cancer center is the only facility in central east Tennessee that uses HDR brachytherapy to treat people with lung cancer and women who have cancer of the cervix, uterus or vagina. This treatment may supplement conventional x-ray therapy, chemotherapy and surgery. It involves a multidisciplinary team that may include medical and radiation oncologists, surgeons, pharmacists, respiratory therapists, radiation therapists, nurses, and others. Patients at Methodist benefit from HDR brachytherapy in several ways. The procedure precisely targets cancer cells with high levels of radiation, which have a greater effect on the malignant cells than do lower levels. Patients have fewer side effects because of reduced radiation exposure to normal tissue. Patients with lung cancer are less likely to develop pneumonia because HDR brachytherapy frequently prevents airway obstruction by a tumor. The treatment is an outpatient procedure. The time frame for performing the procedure, including preparation and recovery, may be as much as four hours. However, this time frame compares favorably to the one-to-three days of hospitalization required for low dose rate brachytherapy. Family members and health care personnel are not exposed to radiation, as they are when patients undergo low dose rate brachytherapy. Advanced Technology: 120-leaf Multileaf Collimator High doses of radiation, when not precisely targeted, can pose substantial risks to healthy tissue and organs near a cancerous tumor. Consequently, Thompson Cancer Survival Center at Methodist recently installed a state-of-the-art multileaf collimator. It is the latest, most capable tool of its type in the region. This technology helps radiation oncologists at the cancer center deliver higher doses of radiation to tumors, using static Intensity Modulated Radiotherapy Treatments (IMRT). With static IMTR, the physicians can vary the dose intensity and "paint" the tumor with radiation, while sculpting the beam to avoid surrounding tissue. The overall result is better patient outcomes. Pain Management Methodist's inpatient cancer unit has made a commitment to focus on pain management in order to improve patients' quality of life. The nursing staff now considers pain the fifth vital sign and regularly monitors it along with temperature, blood pressure, heart rate, and respiration. Patients learn how to rank their pain. Based on pain rankings, the nursing staff works with patients' physicians to aggressively treat pain as needed. Clinical Trials Methodist has provided cancer patients and others access to various clinical studies for a number of years. Through its association with Thompson Cancer Survival Center in Knoxville, Tennessee, it currently offers women in surrounding communities an opportunity to participate in the Study of Tamoxifen and Raloxifene (STAR) and men to participate in the Selenium and Vitamin E Cancer Prevention Trial (SELECT). These clinical trials are among the largest-ever studies on breast and prostate cancer prevention. STAR will eventually include 22,000 postmenopausal women at increased risk of developing breast cancer to determine whether raloxifene, an osteoporosis prevention drug, is as effective in reducing the risk of breast cancer as tamoxifen. Participants randomly receive either tamoxifen or raloxifene daily for five years. They have regular follow-up evaluations, including breast exams every six months, mammograms, gynecologic exams, and lab work annually. SELECT seeks to determine whether two dietary supplements, vitamin E and selenium, can protect men against prostate cancer. Prostate cancer is the second most common form of cancer in men. Upon enrollment, participants are randomly assigned to one of four groups. One group takes 200 micrograms of selenium daily plus an inactive capsule, or placebo, that looks like vitamin E. Another group takes 400 milligrams of vitamin E daily along with a placebo that looks like selenium. A third group takes both selenium and vitamin E, and the final group takes two placebos. They have regular follow-up evaluations, including a prostate-specific antigen blood test (PSA) and a prostate examination every year at no cost to them. This study will ultimately include 32,400 men from the United States, Puerto Rico, and Canada and will take up to 12 years to complete. Support Services A diagnosis of cancer is extremely frightening, and Methodist's oncology program offers several support services to ease the apprehension and stress that patients and their families typically feel. These services include: Same-day consultation with a surgeon for people diagnosed with breast cancer. Free, temporary housing for people who travel to Oak Ridge for extended outpatient treatment, their families, and families of hospitalized patients, with cancer patients and their families having priority. Emotional and social support through Methodist's relationship with The Wellness Community of East Tennessee. Same-day consultation: People who have mammograms at the Oak Ridge Breast Center, which is associated with Methodist, meet with one of the center's radiologists to receive a diagnosis of breast cancer. Immediately following the visit, an employee of the breast center escorts the patient to the office of a surgeon on Methodist's medical staff for a consultation on treatment options. Then, a case manager from cancer services meets with the patient upon admission to the medical center for surgery. Free, temporary housing: The Hospitality House of Methodist Hospital Foundation opened in early 1997 to help relieve the financial burden that patients and their families face when they travel to Oak Ridge for extended medical treatment. The goal is to ease their financial worries by providing free lodging and allow them to focus all of their energy on the patient's health. Financial support to renovate the house came entirely from charitable contributions by individuals, civic groups, businesses, and others. The house continues to totally rely on contributions through Methodist Hospital Foundation. Methodist's Hospitality House contains four apartments, a shared kitchen-dining area, and a living room for guests, and small offices for the house director and hospital volunteers. It is truly a community effort. Gifts of furniture, paintings, needlepoint, and window treatments, along with murals by the artist who painted the cancer center walls, create a homey atmosphere. Outside, guests can relax in the rocking chairs on the large front porch, escape to the peaceful atmosphere of the back deck, and enjoy the garden areas that local garden clubs created and maintain. Psychological, educational and social support: Methodist works closely with The Wellness Community of East Tennessee, which provides psychological, educational and social support services for cancer patients, their families and friends. These services help patients focus their energy on improving their quality of life, reducing stress, and regaining control of their lives. Specifically, The Wellness Community offers support groups, programs by licensed psychotherapists, sessions on stress management, educational workshops, and social events. There is no charge for any of these services. End-of-Life Care The Comfort CareTraxSM program was created by an interdisciplinary team of physicians, nurses, pharmacists and other healthcare professionals at Methodist. It provides a plan for end-of-life care. Originally developed for terminally ill cancer patients, it now also focuses on meeting the physical, emotional and spiritual needs of other terminally ill patients, as well. With a case manager at their side, patients receive aggressive treatment of their symptoms and learn more about pain management, nutrition, medication and other aspects of palliative care. Six to eight weeks after the patient dies, the case manager contacts the family to offer additional support and provide information on bereavement services when needed. Comfort CareTraxSM is now available to all terminally ill patients hospitalized at Methodist Medical Center, if referred by the physician or the nursing staff. It is one of 33 CareTrax(SM) that the medical center has developed since 1993. Other oncology-related pathways help patients with breast cancer surgery and cancer symptom management. These efforts have not only improved patient care and satisfaction, but have also helped reduced length of stay and costs.

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