CCE Gynecologic Oncology: Yale Cancer Center

Yale

Cancer Center
New Haven

, Connecticut

Although it happened 16 years ago, Emily Fine, MD, still clearly remembers the call she got from a patient complaining that “something didn’t feel right” in her abdomen. Upon examining the woman Fine, a partner in a Hamden, Connecticut gynecology practice, discovered a large pelvic mass. She called the attending physician at the Yale Comprehensive Section of Gynecologic Oncology, who scheduled the patient for an ultrasound the same afternoon.

“The attending met me in the imaging department and reviewed the images with me,” Fine recalls. “We determined it was an ovarian carcinoma. He introduced himself to the patient, had her admitted that night, and operated the next day.” Today, she says, the patient is healthy and cancer-free.

Quick Response, Attention to Patients
Quick response and attention to patients’ needs are typical for the section, part of the Department of Obstetrics, Gynecology & Reproductive Sciences at the Yale School of Medicine. Together with its pioneering research and comprehensive approach to patient treatment, it is why Yale has been named a Clinical Center of Excellence for gynecologic oncology.

“There is a great dedication among our staff towards our patients,” notes Thomas Rutherford, MD, PhD, associate professor and section chief. “If I say we’re working Saturday, there’s no hemming and hawing. Everyone is here, doing it for the patient.”

The section was formed as a sub-specialty of Yale’s obstetrics/gynecology department in 1979. “It was evident that the kind of work we did was so unique that it didn’t make sense to continue us as part of the general division,” explains Peter Schwartz, MD, the John Slade Ely Professor of Obstetrics, Gynecology & Reproductive Sciences and first head of the section.

Starting with three physicians, gynecologic oncology today includes five faculty and an annual budget of about $6 million. The number of new and returning patients treated has grown from 2,050 in 2003 to 8,300 in 2008. It is part of the Yale Cancer Center, a National Cancer Institute-designated center.

Surgically Aggressive Treatment
The section’s most distinguishing characteristic, according to Rutherford, is an aggressive surgical treatment approach. Its physicians frequently use neoadjuvant chemotherapy to debulk patients, a treatment method for patients with advanced-stage ovarian cancer which Schwartz pioneered in the late 1970s. Rutherford explained that chemotherapy treatment prior to surgery has been shown to lead to shorter hospital stays, a decreased need for blood transfusions, and better outcomes.

The fact that patients can receive both chemotherapy and surgery at Yale also sets it apart from many other gynecological oncology centers, Rutherford believes. “We don’t just operate and then send the patient to medical oncology,” he says. “If the patient has a problem with any aspect of their treatment we’re right here for them. We don’t have to refer her back anywhere.” Yale physicians also treat benign and premalignant-style tumors, as well as gestational trophoblastic disease and soft tissue tumors of the pelvis.

Research a Key Part of Mission
Research, particularly in the early detection and treatment of ovarian cancer, has been a key part of the section since its beginning. Along with his development of neoadjuvant chemotherapy treatment, Schwartz’s research in the late 1970s led to the first clinical trial using anti-estrogens for arresting the growth of cancer in some patients with advanced or recurrent ovarian cancer.

More recently, research originated by Gil Mor, MD, PhD has resulted in a clinical trial, now in phase 3, to see whether phenoxodiol can lower the body’s resistance to carboplatin in patients where carboplatin has proven ineffective.

In addition, Mor, Schwartz, and Rutherford were part of a research team that developed a blood test that detects early stage ovarian cancer with 99 percent accuracy. Joanne Weidhaas, MD, PhD, assistant professor in the department of therapeutic radiology, has found a single-nucleotide polymorphism that is thought to be associated with a higher incidence of ovarian cancer. A study of the SNP’s prevalence and significance in the population is under way. In addition, the section participates in clinical trials of investigational anticancer agents that are staffed by three clinical trial nurses. It is currently taking part in six such trials.

Much of the support for the section’s research and clinical care comes from Yale’s Discovery to Cure program. Begun in 2003, Discovery to Cure provides funding to department researchers for connecting basic scientific research and clinical care in areas such as development of new therapeutics, identifying disease markers, and new prevention methods. Discovery to Cure funds helped pay for the equipment Weidhaas used in her SNP research and for Mor’s early research on phenoxodiol.

High Patient Satisfaction
Inpatient and outpatient care takes place at Yale-New Haven Hospital. The 28-bed inpatient unit consistently ranks among the hospital’s highest in its patient satisfaction surveys. Vincent Lynch, MD, an obstetrician/gynecologist in New Haven says, “Their nursing and patient care is excellent. My patients really like it there and feel they’re being well cared for.”

“We make sure the patient is taken care of from soup to nuts,” says Rutherford. “Patients have our direct contact phone numbers and if there [is a problem], they know they can just pick up the phone and we will take care of it for them.”

Lynch says that unlike some other academic-based medical centers, Yale’s gynecologic oncologists enjoy good relations with community physicians. “They always get back to you, they’re always willing to talk to you about problems with patients or to help out in a difficult surgery,” he says. The Yale doctors invite their community colleagues to participate in Grand Rounds and tumor boards, and give lectures and seminars geared to their needs.

Fine, who has practiced since the early 1980s, says even patients who have moved closer to Boston or New York have chosen to remain with her because of her ties to Yale. “The care at centers in those places can be outstanding, but my patients tell me it’s much less personal and more difficult to navigate.”

In contrast, she says, “We are able to get patients in expeditiously, the care and follow-up are excellent, the communications are outstanding. Dealing with them has always been a positive experience.”