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NOVEMBER / DECEMBER 2004

FEATURES

Acibadem targets breast cancer with latest education program

Dr. Lowell E. Schnipper

Acibadem Healthcare Group, behind an ambitious plan to become the focal point of progress for health care in Turkey, has teamed with HMI to develop a series of multidisciplinary education programs for physicians and nurses in the Acibadem network. October is international Breast Cancer Awareness Month, and Acibadem marked the occasion with a two-day oncology program led by Dr. Lowell Schnipper.

Since the HMI-Acibadem partnership was initiatied a little over a year ago, HMI has been working with Acibadem to optimize the concept designs of planned facilites, in addition to developing education programs for physicians and nurses and supporting quality improvement efforts. Acibadem has recently opened Kozyatagi Hospital, a center of excellence for oncology and neuroscience. The leadership of Acibadem sees the continual infusion of new knowledge and research as an integral piece in the development of Kozyatagi Hospital into a top resource for oncology care. The overarching objectives of the oncology program were to reinforce the concept of team-oriented care for cancer patients, and to discuss how Acibadem can establish a multidisciplinary cancer clinic that leverages the expertise of medical oncologists, surgeons, nurses, social workers, radiologists, radiation oncologists, and pharmacists to not only provide the best medical care, but also to address psychosocial and educational needs of patients and families.

“ I am very pleased with what has been accomplished. We worked with our own clinical staff, had visitors from the medical community who attended the conference, and had a very emotional meeting with lay people from the community, most of them cancer patients,” said Prof. Dr. Metin Cakmakci, medical director of Acibadem.

Schnipper, the Theodore and Evelyn Berenson professor of medicine at Harvard Medical School, worked with HMI and the clinical leadership at Acibadem to design a program addressing the continuum of cancer care, with a full day dedicated to breast cancer. In addition to discussions of the biology of cancer—and approaches to managing and treating it—the program focused on building a team-oriented approach to providing compassionate, comprehensive care for oncology patients.

Commitment to enhancing care
" We are currently witnessing a knowledge explosion in the field of oncology, with new information about the biology of cancer emerging in laboratories around the world,” said Schnipper, who leads the oncology division at Beth Israel Deaconess Medical Center (BIDMC) in Boston. “I am impressed and inspired by the vigor with which HMI’s partners in Turkey are working to enhance the care of breast cancer patients. Acibadem is now poised to develop a multi-disciplinary breast cancer program which could serve as the prototype for other programs to be developed there.”

Cakmakci added, “Acibadem Healthcare Group is committed to the idea of multidisciplinary health clinics and centers and is determined to realize this approach in every appropriate area of medicine and applicable disease—but especially in cancer clinics.”

Acibadem’s breast cancer clinic is already beginning to provide care. “We aim to be able to prospectively plan treatment for each patient and achieve synergy among our different units and professionals, instead of providing care independently as we have traditionally,” said Cakmakci. “Our ultimate goal is to ensure that our patients do not feel lost in the complicated process of getting care within the intricate health care delivery systems of today. This two-day education program met our needs, enabled us to notice our missing pieces, and inspired a lot of local solutions.”

Breast cancer is the most common cancer among women worldwide, and is on the rise, according to the World Health Organization’s International Agency for Research on Cancer. The number of women with breast cancer increased 26 percent from 1980 to 1985, and the organization estimated 1.2 million new cases and 500,000 deaths from breast cancer worldwide in the year 2000.

The program was attended by representatives from the oncology, surgery, radiation oncology, radiation, and nursing departments at Acibadem. In a series of lectures, Schnipper traced cancer from its genesis in the cell through the numerous pathways critical to its development, highlighting opportunities to inhibit critical steps in the life cycle of the cancer cell, and exploring the current thinking about the genetic predisposition to breast cancer. He discussed the basic concepts that form the foundation of contemporary breast cancer therapy, including considerations for both local and systemic treatment, new hormonal agents that have been introduced into the clinic, and the promise held by targeted therapy.

“One of my objectives in these lectures was to make clear the basis for optimism about major progress against cancer within the next five to ten years, ” said Schnipper.

From left to right: Hester Hill Schnipper, LICSW, BCD; Chris Richards, RN, MSN; and Saliha Koc, RN, Director of Nursing at Acibadem.

Introducing a team-oriented approach to care
The program went beyond the laboratory to explore approaches being employed in clinics, where nurses and social workers play a key role in helping patients and their families cope with cancer. Chris Richards, RN, MSN, is the clinical nurse specialist for BIDMC’s hematology/oncology outpatient department. She talked about the nurse’s multifaceted role in the care of breast cancer patients, not only in surgery and radiation, but also as it relates to pre-operative education, post-operative care and potential complications, and helping patients who are receiving radiotherapy.

“The concept of multidisciplinary care centers around the provision of a comprehensive, individualized plan of care for the patient facing breast cancer. This plan addresses the needs of the patient from a holistic perspective and requires input from different members of the health care team,” said Richards. “Acibadem has all of the resources that make up a multidisciplinary cancer care team, but they have been working independently. Now it’s just a matter of pulling them together to work as a group. I was impressed with the eagerness and willingness on the part of everyone I met at Acibadem to embrace this concept and carry it forward.” Richards added that while Acibadem is at the cutting edge of technology, the notion of patient advocacy as part of the care provider’s role is new.

Hester Hill Schnipper, LICSW, BCD is the chief of oncology social work at BIDMC. She has worked in the field of psychosocial oncology for more than twenty-five years, and her insight into the care of breast cancer patients is informed not only by her experience as a clinician, but by her own treatment for breast cancer. She led a workshop at Acibadem on how to establish a working system of oncology social work and a minimally guided patient support network. Support and communication are critical for patients both before and after treatment. “Oncology social workers facilitate patients’ adjustment to a diagnosis and treatment of cancer and, working with the family and the interdisciplinary medical team, work towards optimal coping and functioning through the cancer experience,” she said.

During the workshop, Hill Schnipper discussed the value of individual counseling, support groups, patient/peer support networks, and other ways of fostering community among oncology patients. Currently, the role of oncology social worker does not exist in Turkey, but Hill Schnipper and the clinical leadership at Acibadem believe that psychologists and nurses on staff at the hospital may be able to take the lead in developing and leading patient/peer support groups.

The program closed with an emotional discussion between the HMI faculty and members of the Istanbul community, many of whom were cancer patients. The HMI faculty fielded a wide range of questions from the audience. “I was quite moved by the openness of the people who shared their life experiences with us and sought counsel,” said Richards.

More education programs are on the way for Acibadem’s physicians and nurses. In November, Dr. Galen Henderson of Brigham and Women’s Hospital will lead a workshop with Mary Amatangelo, NP and Dr. Andrew Cole on the management of cerebrovascular disease and epilepsy.