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Colorectal Cancer: Georgetown University's Team Approach

Insights From:John L. Marshall, MD, Georgetown University Hospital;Mohamed E. Salem, MD, Georgetown University Hospital;Monica Chacha, RN, BSN, OCN, Georgetown University Hospital
Published: Wednesday, Aug 10, 2016


Transcript:

John L. Marshall, MD:
Welcome to Georgetown University’s Lombardi Comprehensive Cancer Center here in Washington, D.C. And, I am very pleased to introduce our team to you and to give you some of our insights and share our experience, if you will, around the management of patients with metastatic refractory colon cancer.

Welcome, everybody. Welcome to Georgetown University MedStar Cancer Network, here, at the Lombardi’s Comprehensive Cancer Center. I’m joined by these fabulous members of our team who are going to share some information. First, Monica Chacha is a nurse who works with us day in and day out, making all the machines run. Welcome. And Dr. Mohamed Salem, who is one of our newest partners in the team who has made a dramatic impact on cancer patients and clinical research. So, thanks a lot.

I wanted to start by talking a little bit about our center. It’s a big, busy center, as most comprehensive cancer centers in the middle of a city are. We see nearly 1000 new GI cancer cases a year, and we’re only the tip of the iceberg of a really large team. We focus not only on basic clinical care, but also trying to do cutting-edge research to try and change the way outcomes come for patients with colorectal cancer and other GI cancers. First, I want to talk a little bit who we are representing, and maybe, Monica, you go first, on other members of the multidisciplinary team that we rely on day in and day out.

Monica Chacha, RN: I think some of the people that help me most in my responsibilities are those in nutrition. We refer people to nutrition almost every day, helping with things like eating through nausea, eating when you don’t feel like it. Because you have to maintain energy when you’re on chemotherapy. And, then, another person that is really a good resource is our social worker. Our social workers are some of the people that I go to the most. They help with a range of things in home healthcare. They help with referring to support programs or anything like that.

John L. Marshall, MD: So, let’s think about other nurses, too. Obviously, you’re the mother for a lot of these patients, and take care of anything. But, so many other nurses touch them through the course of their treatments.

Monica Chacha, RN: Yes, absolutely. We have our nurse practitioners that sometimes they’ll see in the clinic along with the physician. And, then, another really important part is the infusion nurses. And these are nurses that they see almost every week that give them their treatments, talk to them about labs, and they do education as well.

John L. Marshall, MD: Dr. Salem, other key members of our multi-D team.

Mohamed E. Salem, MD: I totally agree. I think I would steal your quote, “It’s a team sport.” So, cancer care is very complex. And you can imagine when patients get diagnosed with colon cancer or any cancer, it’s the most stressful news a patient can get. And to be able to navigate through this process from the time they go for an appointment until they get their first infusion treatment, it’s a very complex process. It starts with patient navigation. Go for the appointment, get the records, and so on and so forth. But, then you come here and you have the medical oncologist, and you have the nurses who play a huge role in the care. And then those members that do the scans and the blood tests, and the nutritionists, and pain management team, so on and so forth. I think it needs a village, as you say, to take care of that.

John L. Marshall, MD: Yes. We’re so blessed. We have incredible interventional radiology and surgery. Just today, we needed somebody to get a paracentesis this morning, and they’re there to do it for us right away. So, the surgeons, radiation oncology, interventional radiology, all are critical to the successful management of a patient with colorectal cancer.

I was thinking about colon cancer patients, in general. They’re young; they’re old; they’re men; they’re women. They have some unique issues. We take care of different kinds of patients with GI cancer. What do you think is something unique about colorectal cancer patients that we see and notice?

Mohamed E. Salem, MD: I think one of the aspects in colon cancer that is very close to my heart is actually colon cancer in a younger adult. Colon cancer itself causes a huge impact on life, but also being a young adult actually adds to that layer of stress. For example, I had one of my patients who is about 35 years old and was diagnosed. And then she had a daughter, about 12 years old, and she was asking me to arrange her chemotherapy infusion to match where she wanted to take her daughter to school and bring her back home. And her husband has to take off those days, and so on and so forth. So, I think it actually makes it very challenging. We, as a team, have to listen to you and to understand clearly what you need, and what you are looking for. And we try to adjust, as much as we can, our treatment and our plan to do things.

John L. Marshall, MD: Monica, your side on that. Anything unique about these folks?

Monica Chacha, RN: Yes. I think we’re dealing with people here who are trying to maintain their lives, like he said. They’re trying to work, or they’re trying to still go on vacation, or still spend time with friends and family. And, then, at the same time, these same people are having to come to the hospital once, maybe twice a week, and then dealing with all the side effects.

John L. Marshall, MD: And wear that pump.

Monica Chacha, RN: Yes, exactly, the 5-FU pump. Can they go to the grocery store with it? That’s the question I always get. Am I allowed to leave my house with the pump? So, yes, they have a lot going on; a lot of things that they’re trying to balance.

John L. Marshall, MD: And, they live a long time, right? They are going to be our patients for a long time, hopefully longer still, so they bring a lot of unique characteristics. So, it’s a busy center; patients are living longer; it takes a big village to take care of all these patients. That’s the secret to the most success for treatment of colorectal cancer.

Monica Chacha, RN: Education is so important, and it’s a huge part of my role as a nurse. That is really the main thing that I do with patients. Another thing that I do is try to create a rapport with people. And, in the end, I have a lot of patients that say we’re almost more friends than we are nurse and patient. I think the relationship there is very key for me, because it gives me an inroad to be able to speak with patients. A lot of times they’re going to have an open ear to what I say. They only may give a little bit of the information to the physician. Whereas with some patients, I’m literally talking to them every day, sometimes even a couple times a day. They’re updating me with how they’re feeling, what’s going on, and that’s just a really good relationship for me to be able to talk to them about side effects.

Transcript Edited for Clarity
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Transcript:

John L. Marshall, MD:
Welcome to Georgetown University’s Lombardi Comprehensive Cancer Center here in Washington, D.C. And, I am very pleased to introduce our team to you and to give you some of our insights and share our experience, if you will, around the management of patients with metastatic refractory colon cancer.

Welcome, everybody. Welcome to Georgetown University MedStar Cancer Network, here, at the Lombardi’s Comprehensive Cancer Center. I’m joined by these fabulous members of our team who are going to share some information. First, Monica Chacha is a nurse who works with us day in and day out, making all the machines run. Welcome. And Dr. Mohamed Salem, who is one of our newest partners in the team who has made a dramatic impact on cancer patients and clinical research. So, thanks a lot.

I wanted to start by talking a little bit about our center. It’s a big, busy center, as most comprehensive cancer centers in the middle of a city are. We see nearly 1000 new GI cancer cases a year, and we’re only the tip of the iceberg of a really large team. We focus not only on basic clinical care, but also trying to do cutting-edge research to try and change the way outcomes come for patients with colorectal cancer and other GI cancers. First, I want to talk a little bit who we are representing, and maybe, Monica, you go first, on other members of the multidisciplinary team that we rely on day in and day out.

Monica Chacha, RN: I think some of the people that help me most in my responsibilities are those in nutrition. We refer people to nutrition almost every day, helping with things like eating through nausea, eating when you don’t feel like it. Because you have to maintain energy when you’re on chemotherapy. And, then, another person that is really a good resource is our social worker. Our social workers are some of the people that I go to the most. They help with a range of things in home healthcare. They help with referring to support programs or anything like that.

John L. Marshall, MD: So, let’s think about other nurses, too. Obviously, you’re the mother for a lot of these patients, and take care of anything. But, so many other nurses touch them through the course of their treatments.

Monica Chacha, RN: Yes, absolutely. We have our nurse practitioners that sometimes they’ll see in the clinic along with the physician. And, then, another really important part is the infusion nurses. And these are nurses that they see almost every week that give them their treatments, talk to them about labs, and they do education as well.

John L. Marshall, MD: Dr. Salem, other key members of our multi-D team.

Mohamed E. Salem, MD: I totally agree. I think I would steal your quote, “It’s a team sport.” So, cancer care is very complex. And you can imagine when patients get diagnosed with colon cancer or any cancer, it’s the most stressful news a patient can get. And to be able to navigate through this process from the time they go for an appointment until they get their first infusion treatment, it’s a very complex process. It starts with patient navigation. Go for the appointment, get the records, and so on and so forth. But, then you come here and you have the medical oncologist, and you have the nurses who play a huge role in the care. And then those members that do the scans and the blood tests, and the nutritionists, and pain management team, so on and so forth. I think it needs a village, as you say, to take care of that.

John L. Marshall, MD: Yes. We’re so blessed. We have incredible interventional radiology and surgery. Just today, we needed somebody to get a paracentesis this morning, and they’re there to do it for us right away. So, the surgeons, radiation oncology, interventional radiology, all are critical to the successful management of a patient with colorectal cancer.

I was thinking about colon cancer patients, in general. They’re young; they’re old; they’re men; they’re women. They have some unique issues. We take care of different kinds of patients with GI cancer. What do you think is something unique about colorectal cancer patients that we see and notice?

Mohamed E. Salem, MD: I think one of the aspects in colon cancer that is very close to my heart is actually colon cancer in a younger adult. Colon cancer itself causes a huge impact on life, but also being a young adult actually adds to that layer of stress. For example, I had one of my patients who is about 35 years old and was diagnosed. And then she had a daughter, about 12 years old, and she was asking me to arrange her chemotherapy infusion to match where she wanted to take her daughter to school and bring her back home. And her husband has to take off those days, and so on and so forth. So, I think it actually makes it very challenging. We, as a team, have to listen to you and to understand clearly what you need, and what you are looking for. And we try to adjust, as much as we can, our treatment and our plan to do things.

John L. Marshall, MD: Monica, your side on that. Anything unique about these folks?

Monica Chacha, RN: Yes. I think we’re dealing with people here who are trying to maintain their lives, like he said. They’re trying to work, or they’re trying to still go on vacation, or still spend time with friends and family. And, then, at the same time, these same people are having to come to the hospital once, maybe twice a week, and then dealing with all the side effects.

John L. Marshall, MD: And wear that pump.

Monica Chacha, RN: Yes, exactly, the 5-FU pump. Can they go to the grocery store with it? That’s the question I always get. Am I allowed to leave my house with the pump? So, yes, they have a lot going on; a lot of things that they’re trying to balance.

John L. Marshall, MD: And, they live a long time, right? They are going to be our patients for a long time, hopefully longer still, so they bring a lot of unique characteristics. So, it’s a busy center; patients are living longer; it takes a big village to take care of all these patients. That’s the secret to the most success for treatment of colorectal cancer.

Monica Chacha, RN: Education is so important, and it’s a huge part of my role as a nurse. That is really the main thing that I do with patients. Another thing that I do is try to create a rapport with people. And, in the end, I have a lot of patients that say we’re almost more friends than we are nurse and patient. I think the relationship there is very key for me, because it gives me an inroad to be able to speak with patients. A lot of times they’re going to have an open ear to what I say. They only may give a little bit of the information to the physician. Whereas with some patients, I’m literally talking to them every day, sometimes even a couple times a day. They’re updating me with how they’re feeling, what’s going on, and that’s just a really good relationship for me to be able to talk to them about side effects.

Transcript Edited for Clarity
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