Eastside Health Network Newsletter
Newsletter is sent to providers in our network, stakeholders are our partner hospitals, and payors and businesses EHN collaborates with. Took newsletter from average open rate below 20% to average open rate of 32.4% and high of 47.4%.
Eastside Neuroscience Institutes’ Comprehensive Approach to Treating Neurological Tumors
It probably wouldn’t surprise you to hear that neurosurgery is complicated. Not just the surgery itself but the entire pathway of care for the patient.
Providers in neurosurgery at Overlake Medical Center & Clinics and EvergreenHealth are addressing these complexities with a neurological tumor board that meets twice a month.
The tumor board discusses cases of patients who are being treated for tumors, suspected tumors, or any other complex findings that would benefit from team discussion. Meetings last about half an hour and generally cover three or four cases: At present, Dr. Amitoz Manhas leads these meetings.
Dr. Manhas is a board-certified neurosurgeon at Overlake Medical Center & Clinics who specializes in complex neurosurgery. He performs a variety of types of neurosurgery, but he has received specialized training in skull base surgery, as well as neuro-oncology.
His neurosurgical partners in this work are Drs. Dustin Hayward and Ryder Gwinn at EvergreenHealth, as well as Dr. Jonathan Choi at Overlake Medical Center & Clinics.
Tumor board meetings are coordinated through the Eastside’s Fred Hutch Cancer Center locations. On the morning of the meeting, the team will meet virtually to review imaging and available pathology reports related to cases. The provider overseeing the case will introduce the clinical presentation. The meeting includes surgeons, radiologists, oncologists, radiation oncologists and neuro-pathologists. This range of specialization helps the team see a complete picture of the disease. Dr. Manhas adds, “We’re capable of treating the wide range of patients who may present with brain and spine tumors.”
Once the case has been thoroughly presented, the team will move on to discuss possible treatment. Has the patient had surgery? If not, does surgery make sense?
If surgery is recommended, patients have the option to schedule at either EvergreenHealth or Overlake Medical Center & Clinics. Most patients schedule wherever their provider works most frequently, but some will choose based on factors like which hospital is closer to home. Both offer state-of-the-art facilities and the latest equipment. Patients receive great care at either location. And importantly, they do not need to travel outside of the communities here on the eastside of Lake Washington to receive quality neurosurgical care.
As a result of this collaboration with the Fred Hutch Cancer Center, patients can be referred to clinical trials when they qualify. One of the roles of the tumor board is to help facilitate referral into cancer trials that patients might qualify for and connect those patients if they are interested.
Once a recommended path of treatment is decided, patients are contacted by nurse navigators. Nurse navigators walk patients through logistics of perioperative cancer care. They help the patients understand what to expect and answer any questions that the patients or their families have along the way. Their job is to make patients feel comfortable and to help coordinate the care during this important time.
Dr. Manhas and the board are happy to receive referrals from primary care providers (PCPs) at any time along this process, including cases of incidentally found tumors. Dr. Manhas especially recommends urgent referral if a patient exhibits neurological changes, such as weakness, numbness, or problems with speech or coordination, as examples. Patients can be seen quickly in order to address whatever questions or concerns might arise. When a patient needs treatment, the specialty team will take care of them and then send them back to the PCP once the cancer care has been completed. They will always work to keep the PCP in the loop regarding the patient’s status along the continuum of care.
It’s a team effort. And a collaboration between two hospital systems. Everyone works together to ensure the best care for patients. For Dr. Manhas, “Having every team member move forward with a well-informed plan has made for a confidence-inspiring approach to patients with tumors.”
For more information on Dr. Manhas, his colleagues, and the tumor board, contact the Tumor Board at 425.899.2274 or neurosurgical offices in Bellevue 425.635.6560 or Kirkland 425.899.3135.
Developed 5-Questions feature for EHN newsletter in 5th anniversary year as way for extended network to better get to know EHN employees and to build culture among EHN staff.
5 Questions with EHN Medical Director John Nelson, MD
To celebrate our 5th year, we're running a special feature: Five questions with employees of Eastside Health Network (EHN). This month, for the last of our special 5th-year-anniversary features, we talk to EHN Medical Director, John Nelson, MD.
You would be hard pressed to find anyone who can talk about John Nelson without smiling.
He’s just that kind of guy.
John is good at what he does, but he will also engage you in conversation about everything from basketball to what animal he would like to be (an eagle), and he’s interested in the people around him. John cares about connecting with his colleagues. You can see evidence of that care in the depth of relationship he has with everyone who works with him.
John is also EHN’s longest-serving employee and has been here almost since day one. Lucky us!
John describes himself as a utility player. Part of his job is to help interface with providers, particularly making initial contact with prospective network members and doing site visits with Payor/Provider Relations Liaison, Amanda Dorman.
John also gives an important clinical perspective to all our work. “I feel like I speak for the providers in EHN deliberations,” he says. John continues, “I try to wear the hat of a provider, present their point of view.” When EHN staff discusses issues related to coding, HEDIS measures, contracts, or other administrative topics, John keeps us grounded in what it’s like in the life of a provider and how these matters might impact them day to day. John is our resident expert.
Perhaps John’s favorite work is the work he does with provider wellbeing. John organizes small cohorts that meet weekly for six weeks to discuss stresses related to the job. The program is based on one piloted by the Mayo Clinic. The goal is to minimize stress and burnout, which unfortunately, are big issues for many providers.
If you know EHN, you probably know John. But below is your opportunity to learn a little more about him.
What do you like about working at EHN?
The people. And the culture.
And the mission. I feel like we’re involved in helping to guide the Eastside toward newer models of health care. We’re helping to build the things that are important to have in our future health care systems: data tracking, capturing data and analyzing, reporting performance on processes and outcomes important to patients.
How has EHN changed since you joined?
It's a lot bigger. We now have departments within EHN. At the beginning, it was just had a handful of people.
You like to ask this question to each new hire, and I’m sure you know where I’m going … What was your first concert?
Jethro Tull. It was my first album, too. Thick as a Brick.
Can you tell us about your pet situation in your work-from-home environment?
I seldom work from home, but I am lucky enough to have had in my life and my family’s life the greatest dog to walk the Earth, and anybody who disputes that is itching for a fight. And he died suddenly and unexpectedly two days before lockdown.
We got another dog, who I’m also quite attached to, but is quite a behavior problem. Her name is Harper.
Working in health care can be draining, especially these days. What is your favorite type of self-care?
The main thing is I play guitar, which is very much for me like meditating. Everything else leaves my mind. When Covid struck, my schedule changed enough that I could go to bed and get up the same time every day of the week. Good sleep hygiene really made a difference for me.
Swedish Digestive Health Institute Newsletter
Newsletter is sent to other healthcare providers—general practitioners and digestive health providers who are less specialized than the team at Swedish. The newsletter advertises the services at Swedish and reassures providers that their patients will be sent back to them for long-term care once they have sought specialty care at Swedish.
HIPEC—an exciting new treatment for peritoneal cancer
When Evan Ong was in medical school, he was advised to not to be a surgeon if he wanted to work at the cutting-edge of cancer treatment: “As a medical student wanting to go into surgery … a lot of people would say, ‘when we get the magic drug or the magic bullet that can cure cancer, your role in cancer, a surgeon's role in cancer, will be obsolete.’”
Dr. Ong ignored those warnings, and to his surprise, and no doubt the surprise of those who gave the advice, surgery is actually where many of the latest breakthroughs in stage four cancer treatment are happening.
A surgical oncologist at Swedish Hospital, Dr. Ong specializes in gastrointestinal cancers and defines his role as part of the hospital’s vision to bring academic level surgical oncology to Swedish, “so we don’t have to tell our patients … to get this [specialized] treatment, you need to go elsewhere.”
What is HIPEC?
One of the specialized treatments that Dr. Ong offers is hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC is a surgical procedure in two parts. First, cancer is removed from the peritoneal cavity in a radical site reduction. The tumor itself and any metastasized cancer are taken out, as are any affected organs. Dr. Ong calls this process “removing the bulky disease.”
Next, patients are given a heated, high dose of chemotherapy to eliminate any microscopic portions of the disease and reduce the chances of reoccurrence. The abdominal cavity is filled with chemotherapy drug, and the patient is physically rocked back and forth so the drug can reach all areas of the peritoneal cavity. Dr. Ong describes the peritoneal cavity as a balloon: “IV chemo therapy can’t penetrate the … balloon, so [with IV chemotherapy] you can never get a high enough concentration of chemotherapy to eradicate the cancer that’s in the belly.”
Who should have HIPEC?
The HIPEC procedure can work well for a specific type of cancer patient. First, a cancer should be in the peritoneal cavity. The disease should be metastatic but not have spread beyond the peritoneal cavity. Patients must not be currently receiving IV chemotherapy. And patients must be stable enough to undergo major surgery.
Dr. Ong estimates that he and his partner, Dr. Mohamed Alassas, evaluate 300 to 400 patients each year as prospective HIPEC candidates. Those potential candidates slowly get winnowed down to 30 or 40 actual HIPEC operations. Approximately a third of patients begin surgery and are determined not to be candidates at that point. “As you can imagine to undergo an exploration, which is a major operation, just to determine that you can't do the procedure, that it can be pretty distressing on patients,” he says.
Because there are so many steps involved with the evaluation process for each patient, Dr. Ong recommends any physician who is considering referring a patient for HIPEC call him or Dr. Alassas to discuss the potential referral early in the process. They are happy to do an initial assessment of the case and whether HIPEC seems a general possibility over the phone before they even see the patient because a phone screen can save time for patients who are not candidates. The best way to establish who is a good candidate is to open a conversation.
A HIPEC case study
For the patients who qualify, HIPEC can make an amazing difference. One patient who has seen amazing results from HIPEC is Tauna Langridge. Tauna had the procedure in 2014 to remove cancer that began on her appendix and grew to the size of a basketball, making her appear nine-months pregnant.
To remove Tauna’s cancer, it was necessary to resect several organs. Dr. Ong removed Tauna’s appendix, cervix, ovaries, uterus, spleen, gall bladder, colon, appendix, and parts of her liver, bowel, and pancreas. Most organs serve some purpose, but that purpose is not necessary for survival. Removal does impact quality of life, but people can live without the organs if necessary. Dr. Ong stresses that this resection surgery is what makes HIPEC such a difficult procedure for patients.
Because of HIPEC, Tauna is now cancer free—something simple removal of the tumor and IV chemotherapy could not accomplish. Now, more than four years post surgery, she is enjoying life with her family.
Using HIPEC, Dr. Ong is able to help a few dozen patients each year who are not treatable by conventional IV chemotherapy. It is a far cry from the days when he was told that surgeons would have no use at the forefront of cancer treatment.
The future for surgery in treatment of stage 4 cancer
In fact, recent research indicates potential for surgery as the preferred way to manage stage four cancer in some instances. A study presented at the American Society of Clinical Oncology—GI (ASCO—GI) looked at the efficacy of HIPEC for colorectal cancer. The study found that HIPEC was not an effective treatment for colorectal cancer involving the perineum1. But the study also found that the HIPEC resection surgery alone (without the HIPEC chemotherapy process) was more effective against stage four colorectal cancer than IV chemotherapy in patients with either a low volume of the disease or a high volume of the disease. It’s a long way of saying, in some cases, for some patients, in some types of stage IV cancer, surgery is a more effective treatment than IV chemotherapy.
According to Dr. Ong, his career is currently focused on addressing just these issues: “That's probably the question that I'm trying to answer. Is there, and that HIPEC is kind of the thing that's kind of generated that idea and it's the best representation of that idea. But ultimately the big overarching question, how does surgery fit in the role of stage four cancer? And that's kind of what I do.”
Citation
1. Klaver, Charlotte, E.L.K., et al. Adjuvant HIPEC Effective in patients with colon caner at high risk of peritoneal metastases: Primary outcome of the COLOPEC multicenter randomized trial. Presented Jan. 21, 2019, at ASCO doi: https://meetinglibrary.asco.org/record/169314/abstract