Northwest Health Fall 2011

Members Say Integrated Care Made the Difference

Patients with three different types of cancer share their diagnosis and treatment experiences at Group Health.

Go to: Northwest Health Index

No one wants to get that news. But at Group Health, an outstanding team of specialists — plus the latest cancer-fighting drugs and technology — will join you on your treatment journey.

While in her senior year of college in California, Paige Pauli's skin itched so badly that she scratched until she bled. A doctor suggested dry skin was likely the cause. Soon after, she discovered lumps along her left collarbone. She had a needle biopsy and a chest X-ray to investigate her symptoms. Results were inconclusive but suspicious. A second biopsy was recommended, but since Pauli was only two weeks from graduation, she decided to wait until she could return to her home in Seattle.

The day after she graduated, Pauli and her boyfriend drove 18 hours straight to Seattle for the biopsy, which was performed by Thomas Whang, MD, a surgeon at Group Health's Capitol Hill Campus. She soon had a diagnosis: Hodgkin's lymphoma. At the age of 22, Pauli became a cancer patient.

Cancer treatment has been described as a journey, and Pauli began her journey with all the resources of Group Health by her side — cutting-edge treatment, the latest in technology and clinical trials, and compassionate, integrated care.

An Experienced Team at Your Side

Many advances have been made in cancer treatment and survival is increasingly common, but it's still a scary diagnosis. It helps to know that if you get that diagnosis, you're in a place with experienced cancer care teams.

ALSO SEE: The Cancer Care Team

The Group Health Medical Centers cancer care program treats more than 2,600 new cancer patients a year, says Connie Wiletzky, RN, MSN, service line director for Oncology. Those patients are seen by one of more than a dozen oncologists who work at Group Health clinics in Bellevue, Everett, Olympia, Seattle, Spokane, and Tacoma.

The medical oncologist heading up Pauli's care was Eric Chen, MD, PhD, medical chief for cancer care at Group Health. In Pauli's case, as is typical for all cancer patients, Dr. Chen worked with a team to provide the comprehensive care needed for cancer treatment. A cancer care team typically includes surgeons, nurses, technicians, pharmacists, radiologists, pathologists, and other specialists like social workers, though the precise makeup varies a bit depending on the type of cancer.

Pauli instantly felt in good hands with Dr. Chen, whose advanced training includes a medical oncology fellowship at Fred Hutchinson Cancer Research Center, and a PhD in human cancer biology. But also important was the rapport they developed. "He was really great. I realized early on in the process that I deal with stress with humor, and Dr. Chen always laughed at my jokes. He's been really great with all of my family members who wanted to be in the room as well. He was always so clear, talking through everything, and patient with my incessant questions."

Integrated Care Makes the Difference

Soon after she was diagnosed, Dr. Chen developed a treatment plan for Pauli that included six months of chemotherapy.

Pauli appreciated Dr. Chen's suggestion that a chest port be installed to make her chemo treatments easier. And she especially appreciated that he guided her to an egg retrieval procedure prior to beginning treatment, in case it compromised her fertility. That procedure allowed her to freeze her eggs for use later when she wanted to start a family.

A key component of any treatment plan is the integrated care that Group Health delivers. "Group Health is unique," says Dr. Chen. "Especially in cancer care when there are so many people involved, so many specialists. It truly takes a team effort. We work together to get the sequence of care right."

It's this seamless, integrated teamwork that distinguishes the Group Health cancer care approach from other systems that often operate in a more fragmented fashion. In those systems, oncologists, radiation oncologists, pharmacists, radiologists, infusion centers for chemotherapy, surgeons, and pathologists may be geographically distant, maintain separate patient record systems, and have no clear communication pathway. That means cancer patients must often drag medical records with them to appointments, including imaging or lab results. They have to e-mail, fax, and call a variety of medical offices during their treatment, and it's entirely possible that members of their medical teams don't know one another.

"Here we know each other," says breast cancer surgeon Tien-Bao Chao, MD, who performed more than 150 breast surgeries last year. "It's so easy to pick up the phone and call each other." Or run into one another in the hallway, Dr. Chao says. She appreciates, for example, being able to quickly consult with a plastic surgeon: "I can just go into his office and talk his ear off."

She also points to Group Health's electronic medical records, which put a patient's medical history and care plan instantly at the fingertips of everyone involved with their cancer treatment. "We can just log in and look at records in real time and give an opinion," Dr. Chao says. "Yes, the patient will need radiation. Or yes, the patient will need chemotherapy." Patients don't have to worry about sending documents to different specialists involved with their care.

Our Personal Online Services that allow secure messaging between physician and patient is a great way to quickly communicate. It also allows patients to check their test or lab results. "I could contact all of my doctors there," says Pauli of secure messaging. "The nurses were always really helpful, too. And I could schedule my appointments online."

If Pauli's cancer had turned out to be something unusual or rare, she might have been referred to a specialist outside of Group Health, or a Group Health oncologist might have consulted with that specialist. Patients are referred to the care they need, and children with cancer are treated at Seattle Children's.

"If a patient has an unusual situation or requires expertise not available in their local community or in their network of care, there are ways for them to receive the care they need through affiliations with nationally recognized cancer centers," says Group Health oncologist Janet Chestnut, MD, who practices at Group Health Medical Centers Riverfront clinic in Spokane.

As well, if a patient has seen a Group Health oncologist but wants a second opinion outside of the Group Health system, they can request that.

Julie Case of Seattle, successfully treated for breast cancer six years ago at Group Health, got one of those second opinions during the course of her treatment and found her doctors very supportive. It was a retake of a cardiac test that she had at regular intervals to see if one of her treatment medications was affecting her heart. "I was very impressed with how open they were," Case says.

Case, who was also gratified to have a cutting-edge medication prescribed during treatment, feels so strongly about the excellent care she received that she also contributes to the Group Health Foundation. "We support the Foundation because we're such advocates for the work it does," she says. "It expresses the philosophy of treating the whole person."

Tending to Physical and Emotional Needs

Cancer is more than just a physical disease. It also takes an emotional toll — and helping patients with that is one of the things that social worker Jean Catellani does. Catellani, who works with the Oncology Department, helps patients cope with their cancer diagnosis and treatment. She facilitates a weekly drop-in support group for cancer patients, family, and caregivers. She also helps patients find their voice when talking to medical professionals, something that many people don't have much experience with. "Some people are really intimidated by doctors, and afraid to tell them how they feel," Catellani says. "I help reassure them the doctor is here to support them in whatever decisions they make."

Group Health's progressive approach to cancer care is one of the reasons she chose to practice here. "Our practitioners are very supportive of people, no matter what their cultural or spiritual inclinations. People here are open to complementary medicine. They don't hesitate to work with naturopaths or acupuncturists. They approach everyone as a unique person, catering to needs far beyond chemotherapy or radiation."

Nurses also have a big role in cancer care. Nurse Amy Lynes, ARNP, who works in Radiation oncology at the Group Health Capitol Hill Campus in Seattle, says working here fulfills her intellectually and emotionally. "I like the approach of looking at treatment and care based on the best scientific research and tailoring it to fit the individual patient," says Lynes, who gets involved in many aspects of patient care — from taking medical histories to explaining radiation treatment options and helping patients manage side effects. She interacts with many specialties to find the best path for a given patient. "There's not always just one option in terms of an approach to someone's treatment. I help explain the risks and benefits of each."

Other nurses at Group Health in cancer care do everything from education on various forms of the disease to administering chemotherapy to caring for post-surgical patients and helping with pain management. They answer phone lines and find answers for patient questions, aid in physical rehabilitation, and help manage symptoms.

Robert Kash of Stanwood, who has advanced colon cancer, relies on the nurses who work with him on his treatment. He freely calls his regular nurses in Oncology when side effects from his treatment crop up, and finds they respond instantly. "These people are wonderful, really concerned about me," says Kash. "They kind of pamper me. On a scale of 10, I give them a 10-and-a-half."

He adds: "At Group Health they're concerned about both the latest treatment and the people themselves. I totally believe in what they're doing. I would recommend them to anyone."

A Positive Outcome

Like many cancer patients nowadays, Pauli's story has a happy ending. In December of 2008, she was declared free of cancer. And in August she was married to the boyfriend who drove her home from college for her initial biopsy. She is deeply grateful to the Group Health cancer care team that restored her to health, allowing her the joy of planning and celebrating her wedding. "I felt that Dr. Whang, Dr. Chen, and my RN, Ruth, truly had my best interest at heart," she says of her experience. "I wasn't just another cancer patient. The care in which Dr. Whang communicated my diagnosis, Dr. Chen's patience and sense of humor, and Ruth's commitment to being my nurse for every single one of my treatments, were invaluable and key to my recovery."

Now she can go days without thinking of her ordeal. "It gets further and further away all the time," Pauli says. "I think, 'Did that really happen?' It becomes more and more like a dream every day."

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