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The BMC Brief

The BMC Brief - Volume 8, Issue 10

October 30, 2019

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Multidiscplinary Breast Cancer Clinic Provides Comfort and Coordinated Care to Patients 

Getting a breast cancer diagnosis can be a scary situation for most patients. It brings many questions about prognosis and treatment – and always requires a team of providers to agree on the right treatment plan. Questions about breast cancer treatment can involve many appointments with different doctors. Unfortunately, these appointments can add extra stress for patients, as well as prolonging the process of choosing the right treatment. Doctors at Boston Medical Center are addressing this challenge, with the multi-disciplinary breast cancer clinic.

Previously, patients saw a surgical oncologist after they were diagnosed, followed by a separate appointment with a medical oncologist. In the multi-disciplinary clinic, which started last year, patients are able to see a medical oncologist and surgical oncologist at the same time, often on the same day as learning about their diagnosis

While Naomi Ko, MD, the medical oncologist in the clinic, had been interested in this type of clinic since she started at BMC five years ago, the idea began to truly take shape when Michael Cassidy, MD, the surgical oncologist in the clinic, joined BMC. Ko and Cassidy already shared many patients, which made joining forces for initial visits a logical and easy choice. The clinic also received support from Matthew Kulke, MD, who became Section Chief of Hematology and Medical Oncology and Medical Director of the Clinical Cancer Center in March 2018.

“The most critical time in oncology care is at diagnosis,” says Ko. “Coming together as a team is especially useful at that time, since it helps patients and doctors formulate a treatment plan with multidisciplinary input.”

After a breast cancer diagnosis, patients can often make the choice between having surgery first and having chemotherapy first. The multi-disciplinary clinic helps patients navigate this choice by allowing both the medical oncologist and surgeon to explain the risks and benefits of treatment order, and how medical treatment will affect both their body and their surgical options. This gives patients a fuller picture of their options and leads to better-coordinated care. It also helps patients start treatment earlier, because they do not have to go to appointments with multiple specialists before arriving at a treatment plan.

The multi-disciplinary clinic provides particular benefits to BMC’s unique patient population, who may have a harder time traveling to or taking off work for multiple appointments. While patients still come back for treatment or to follow up with providers, they require fewer visits overall. Coordinating care makes it easier for patients to make treatment decisions and receive timely treatment which leads to better health outcomes.

Currently, the clinic sees two or three newly diagnosed patients per week, plus a few patients for follow-ups. They are hoping to expand hours to more easily accommodate all breast cancer patients, and support them at every stage from diagnosis to survivorship. They also plan to create a clinic specifically for breast cancer survivors to see their oncologists at the same visit and connect with each other on wellness and quality of life issues.

“Cancer care at BMC in general is growing and changing rapidly,” says Ko. “We’re eager to get feedback from other providers on how we can make this experience better for both our colleagues and patients.”

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Socially Responsible Surgery: Creating a Home for Public Health and Advocacy in Surgery

For years, Tracey Dechert, MD, watched as talented medical students with a passion for public health and social justice hesitated­, conflicted, between a career in surgery and other specialties that felt more obviously in sync with their values and interests.

With its intensive training and focus on technical skill and clinical expertise, surgery as a field has been slower than specialties like pediatrics or family medicine to embrace the social determinants of health (SDOH) and other non-medical concerns. As a result, Dechert observes, med students drawn to health equity and underserved patient populations have tended to assume there's no room for that work in surgery, with the notable exception of medical missions and global surgery.

"I kept talking to them individually and convincing them, 'No, that's not true — you can be a surgeon and care about these issues, you can stay local and do this work,'" says Dechert, a trauma and critical care surgeon at Boston Medical Center (BMC) and an associate professor of surgery at the Boston University School of Medicine (BUSM). "I got tired of that conversation and hearing the same things, and that's when I formed the group."

That was five years ago. The group, a half-dozen like-minded med students who first came together over pizza at Dechert's apartment, has since evolved into Socially Responsible Surgery (SRS), a fluid yet fast-growing organization with national aspirations that recently launched its second chapter, at the UC Davis School of Medicine.

Read more on HealthCity

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What do you do, Claire Hacking?

Name: Claire Hacking
Title: Genetic counselor
Time at BMC: Two years

What do you do at BMC?

I’m a cancer genetic counselor, primarily for adults. I speak with patients with either a personal or family history of cancer to help figure out if there are patterns within their personal or family history that make us suspicious that the cancer is hereditary. About half of the patients I see are people who are affected by cancer, and the other half just have a family history.

I talk to patients a lot about their history, but most of the session is spent on family history. We talk about how many other relatives – both who have had and who haven’t had cancer – they have, as much as they know about what kinds of cancer family members have had, and what family members passed away from and at what age. All of that information, along with information about the patient, can help us determine if genetic testing is something they qualify for and if it might be helpful for them as they’re making decisions about their own cancer treatment or screening.

If a patient decides to get testing, I help facilitate the testing itself, which is usually a blood test. I explain to them what results could mean, or not mean. I also help with insurance coverage. I’m an intermediary between a patient and an insurance company, so patients don’t have to deal with that on their own. I can find out what’s covered and help them fill out the paperwork.

A lot of our patients start care somewhere else and then eventually come to Boston and BMC. Genetic testing is pretty new, so although they might have gotten cancer treatment in other countries, genetic testing is rarely be offered.

Getting these patients tested also helps their family who may not be able to get tested. If we find a mutation, the family members can have more information about their health and what screenings may be necessary.

What brought you to BMC?

When I graduated from genetic counseling school, I wanted to live on the East Coast.

When I was interviewing for this job, I really liked what I heard about the mission of the hospital. I also really liked the people I interviewed with. I felt like there was a real team aspect. And I felt that working here, I could really make a difference and offer services to patients who may not be able to get them other places.

What’s something people don’t know genetic counseling and testing?

Some people, usually those who don’t work in health care, ask me if I help make designer babies. We don’t do that.

What we do is help people understand their risks and teach them about genetic testing, so they can decided whether or not they want to do testing. My role is to provide the extra time for education specifically about the testing.

Our genetic tests can’t tell people if they will get cancer, or when they will get cancer. That can be frustrating, because people want answers. But a lot of the time, our tests don’t give hard answers. They can only help you understand your risk for certain cancers.

At-home genetic testing kits have been in the news lately. What’s your view on these kits? Should people use them?

These kits can be fun. I describe them as “infotainment.” You get some information about yourself, and may learn more about where you came from, or fun little quirks. If you’re just doing the testing to learn some fun things about yourself, I think that’s totally fine. Sometimes people find out surprises, so you do have to be ready for that.

But the main negative of these tests is that they’re not fully comprehensive. Some people think that when they do direct-to-consumer genetic tests they’re getting all their genetic information, but that’s not necessarily true. Some of the tests are only FDA-approved for certain things, so once you get outside of those, they’re not necessarily accurate.

If people do genetic testing for health reasons, and find a potential mutation, I really recommend that they follow up with a doctor for testing to verify.

What do you like most about working for BMC?

I really love our patients. They’re all very sweet. My cancer patients especially, are usually very down-to-earth.

I like the team here. I feel like all of the providers I work with really care about their patients and work above and beyond to get things done. There’s a strong sense of camaraderie.

What do you do for fun outside of work?

I really like to hike, backpack, and do a lot of other outdoor activities. I even worked in Alaska for a little while, driving a bus.

I’m from the West, and I feel like people here think driving more than four hours is too far for anything. But not being from here, I go on a lot of these semi-close road trips.

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Awards and Accolades

BMC Receives Two Worksite Wellness Council of MA Awards

BMC has received two awards from the Worksite Wellness Council of MA. The silver award for overall wellness program achievement recognized BMC for developing and implementing a successful and well-rounded wellness program that builds a healthy and resilient workforce.

The Community Award was given both based on what our employees contribute, and what the hospital does as a whole for the community.  This includes partnering with the Boston Builds Credit organization, our Employee as Volunteers program, and BMC’s creation of the stabilization fund to provide grants to community organizations to help families avoid eviction and a housing stabilization program for people with complex medical needs.

Carl G. Streed Jr. Named One of City Awake’s Ten Outstanding Young Leaders

Carl G. Streed Jr., MD, MPH, FACP, Research Lead at the Center for Transgender Medicine & Surgery has been named a recipient of City Awake’s Ten Outstanding Young Leaders Awards (TOYL). The awards celebrate the contributions of current and emerging young greater Boston leaders who have demonstrated professional, personal, and civic commitment to improving the quality of life within our region. The 2019 Ten Outstanding Young Leaders were nominated by members of the community and selected by a committee of past TOYL honorees.

BUSM Departments Rank High in 2020 USNWR Global Rankings

The 2020 U.S. News & World Report rankings of the world’s best global universities and programs have been released. Special congratulations to:

  • Cardiology–10th in the world, 8th in the U.S.
  • Clinical Medicine–46th in the world, 26th in the U.S.
  • Neurosciences–45th in the world, 23rd in the U.S.
  • Psychiatry/Psychology–45th in the world, 25th in the U.S
  • Surgery–104th in the world, 66th in the U.S.

Overall, Boston University was ranked 51, tied with Karolinska Institute, Sweden; King Abdulaziz University, Saudi Arabia; and University of Maryland-College Park.

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News of Note

Sushrut Waikar, MD, MPH Named Chief of Nephrology

Sushrut Waikar, MD, MPH, has been named the new section Chief of Nephrology in the Department of Medicine at Boston Medical Center and the Norman G. Levinsky Professor of Medicine at Boston University School of Medicine.

Waikar studies and cares for patients with acute and chronic kidney diseases. He has been named a Top Doc by Boston Magazine and has published more than 170 articles in peer-reviewed academic journals.

Waikar’s research the identification of biomarkers to improve diagnosis and care of kidney diseases.

Prior to joining BMC/BUSM, Waikar was the Constantine L. Hampers, MD, Distinguished Chair in Renal Medicine at Brigham and Women’s Hospital and Associate Professor of Medicine at Harvard Medical School. He received his undergraduate degree from Amherst College, his MD from Yale School of Medicine, and his MPH from Harvard School of Public Health. He was an intern, resident, and chief resident at the University of California, San Francisco before moving to Brigham and Women’s Hospital and Massachusetts General Hospital for his renal fellowship.

VIAP Presents at the Health Alliance for Violence Intervention

The VIAP team recently presented in Sacramento at the Health Alliance for Violence Intervention, the national network of hospital-based violence intervention programs. In addition, their workshop entitled “Labors of Advocacy, Compassion Fatigue and Wellness Among Hospital-Based Intervention Program Caseworkers, is featured in this month’s Healing Justice Alliance newsletter.

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