By David Greenwald
Photography by Steven A. Heller
|Dr. Dennis Slamon|
There's a homey clutter to Brett's room. A small pile of clothing is banked against one wall. Atop a rolling table is a stack of DVDs - several seasons' worth of The Sopranos, among other titles. A pull-out bed by the window is unmade, its blankets and sheet rumpled. The room is filled with early afternoon December light.
As he reclines on his bed in a pair of sweatpants and a T-shirt, the 29-year-old could easily be relaxing in his room at home in the Inland Empire community of Upland, California — if not for the machinery, monitors and IV pole with its hanging plastic bags of toxic chemicals that slowly drip into his veins. Instead, it is Brett's patient room on 4SW, the solid-tumor oncology unit of UCLA Medical Center, Santa Monica. For Brett, 4SW has become something of a home away from home. Since he was diagnosed in November 2010 with a rare soft-tissue sarcoma known as desmoplastic small-round-cell tumor, Brett has been hospitalized nine times to receive aggressive five-day courses of chemotherapy.
It is a difficult regimen for the gregarious outside sales rep - five days of inpatient chemotherapy, a couple of weeks off to rest, then a one-day outpatient chemo infusion before starting the cycle again — but Brett has managed to remain remarkably upbeat. "Going through something like this can be as much a mental struggle as a physical struggle. Trying to stay positive is really important," he says. He credits his attitude in large measure to the support of his family — his mother, brother or a friend usually stays with him when he is in the hospital — and to the positive attitude and care he has received from the physicians, nurses and staff of the Santa Monica oncology unit.
"The staff here is amazing," he says. "Everybody from the doctors to the nurses to the food-service staff to the people who clean the rooms to the care partners, they are all great. I haven't had one bad experience in any of the times I've been here. I can't say that I look forward to coming here, but when I am here, it is a welcoming and comfortable environment."
The inpatient solid-tumor oncology unit was established at Santa Monica five years ago as part of a strategy to migrate several key services from the old UCLA Medical Center to Santa Monica ahead of the opening of Ronald Reagan UCLA Medical Center in Westwood. Before the move, inpatient solid-tumor oncology occupied space on the eighth floor of the old medical center. But it was not a dedicated unit; patients shared double rooms, and oncology beds were mixed in with other services such as medicine or transplantation. The move to Santa Monica gave solid-tumor oncology its own space for 26 beds and a focused staff of nurses who are specially trained in this care.
Private rooms like Brett's are another significant feature of the unit. All but two of the unit's rooms are private, and each has an alcove with a pull-out bed for a family member or friend to spend the night.
"Having that private room can be so important for many of our patients," says Arash Naeim, M.D. '95, Ph.D., director of the fellowship program for hematology/oncology. "This patient population often comes to the hospital with caregivers or significant others, and the ability for them to have a private space and a place where that other person can stay with them overnight adds to the quality of the care they receive."
In addition to privacy, the rooms also feature flat-screen TVs, and most are equipped with DVD players that were donated by a patient's family, and a couple of game consoles are shared among the patients. Meals are served hotel-style; patients can order what they want (within their dietary restrictions) and have it delivered to their room when they want.
Because patients return over and over throughout the course of their treatment, the relationships that form in the unit can be intense. Patients like Brett and the nurses and staff who care for them form an extended family, says Pattie Jakel, the unit's clinical nurse specialist.
"One of our patients leaves love notes on everyone's door," Jakel says. "He left me one one weekend: 'I love you, Pattie.' I left it up there forever." When a physician asked why she hadn't taken it down, Jakel responded, "Well, no one leaves me love notes at home!"
As Brett observed, no patient looks forward to being in the hospital, "but if they are going to be sick and have to come into the hospital for treatment, they like to be here," Jakel says.
Moving the solid-tumor oncology program from Westwood to Santa Monica made sense on several fronts. Except in cases that require a higher level of monitoring and nursing care — patients receiving consecutive days of infusion or extremely toxic chemotherapy, for example, or who are older or more fragile — most of today's modern cancer treatment is delivered in outpatient clinics rather than in the hospital, notes Dr. Naeim. Santa Monica offered opportunities to develop centralized and multidisciplinary centers that provide services including surgery, medical oncology and radiation oncology in a community location with easy access for patients.
There are 21 oncologists who treat patients at two outpatient locations in Santa Monica, notes Sandra Binder, director of operations for UCLA community practices. The combined clinics treat an average of 40 to 50 patients a day, and therapies range from standard chemotherapy to biological therapies and investigative agents. "There has been increased patient satisfaction, as there is a large open infusion area with multiple windows, allowing great views of the local mountains and the ocean," Binder says.
In addition to opening space for more outpatients, the move also allowed Dennis Slamon, M.D., Ph.D. , chief of the Division of Hematology/Oncology, director of clinical/translational research at UCLA's Jonsson Comprehensive Cancer Center and executive vice chair for research for the UCLA Department of Medicine, to centralize his Clinical Research Unit, which oversees all cancer clinical trials at UCLA and at affiliated oncology offices throughout California and across the country. Dr. Slamon says he is confident that the move will result in the increased recruitment of patients to those clinical trials, which in turn will get new and more effective therapies to patients sooner.
"In the Santa Monica clinics, we are able to see more patients, and we're hoping that many will be able to be treated in clinical trials, where we are testing the leading-edge targeted therapies that are being developed based on our laboratory research," Dr. Slamon says.
Transitioning from Westwood to Santa Monica was not without potential issues, Dr. Slamon notes. "Everything we did in solid-tumor oncology was built around the Westwood campus to support the laboratory and clinical research that we were then taking into the clinic," he says. Moving clinical services to Santa Monica but leaving research in Westwood "presented a scenario where the faculty would have to be shuttling back and forth from their labs in Westwood to the new clinics in Santa Monica."
To address that issue, Dr. Slamon moved the clinician-scientists doing research in solid-tumor oncology to new labs in Santa Monica, called the Translational Oncology Research Laboratories, near the clinics. The new lab space, like the new clinic space, allows Dr. Slamon to centralize the research operations and also place the oncologists closer to the clinics where they are seeing patients.
The translational labs in Santa Monica boast 18,000 square feet of research space and house all the pre-clinical
|Dolores Siegman and Dr. Arash Naeim|
laboratory programs for solid-tumor oncology. Within these spaces, clinician-scientists work to uncover targets for therapeutics, looking for mutated genes that result in protein over- or under-expressions that lead to cancer. Most cancers now are not being treated by organ location, but by the underlying mutation or oncogene that causes the malignancy. The Santa Monica labs also have more than 500 human-cancer cell lines established that represent several malignancies, including breast, lung and colorectal cancers, as well as sarcomas and melanoma.
Expansion of both the clinical and research functions in Santa Monica fits well within Dr. Slamon's continuing plans to enlarge UCLA's footprint when it comes to both the study and treatment of cancer. In 1996, for example, he launched an ambitious program called Translational Oncology Research International (TORI), in which UCLA partners with research institutions, companies and healthcare providers across the United States to offer clinical trials and research studies to patients in their own communities. TORI not only makes enrolling in a clinical trial easier for patients, but it also helps diversify the population represented in the studies.
Currently, TORI has 25 affiliated oncology practices with 130 physicians enrolling patients in UCLA clinical trials. Affiliated TORI sites are located in California from Santa Maria south to Long Beach and east to the Inland Empire and in Colorado, Florida, Georgia, Indiana, Maryland, Nevada, New Mexico and Texas. Each participating practice has a UCLA study coordinator on site. Data from the trials are sent back to the Clinical Research Unit in Santa Monica. To date, the TORI network has placed more than 5,000 patients on UCLA clinical trials, Dr. Slamon says.
"In the chaos of disease, how do we calm ourselves?" asks Dr. Naeim.
It is a difficult question, but UCLA is trying to address it, in part, with a program known as Urban Zen Integrative Therapy. The program, which is being implemented throughout UCLA Health System, has proven to be a very welcome addition to the inpatient solid-tumor oncology unit. Urban Zen delivers yoga therapy, mindfulness meditation, nutrition, Reiki and aromatherapy to the bedside of interested patients. These Eastern approaches, offered in conjunction with traditional Western therapies, are designed to address discomfort due to pain, anxiety, nausea,
insomnia and constipation.
Urban Zen originated with fashion designer Donna Karan based on her experience when her husband was dying of lung cancer in 2001. Distressed that the hospital in New York where he was being treated offered little to ease her husband's pain and anxiety, Karan went on to create a new model for patient wellness. That model has been embraced by UCLA Health System and its leadership.
So far, only a few of the oncology unit's staff have been trained in the techniques, but many have indicated their desire to learn. "It has been remarkable," says Jakel. "I think about a patient who was having an anxiety attack prior to going to radiation. One of the nurses who has been trained dropped what she was doing and went in and did Reiki therapy on that patient, and after 10 minutes she was so much better. It really calmed her down and relaxed her."
That level of engagement with patients is at the core of the care delivered on 4SW, notes Dolores Siegman, interim director of the oncology unit. "Oncology is the truest form of nursing," she says. "You treat the patient. You treat the family. You treat the friends. You treat the spiritual, the physical, the psychological. You are not treating just a disease entity; you are treating the whole patient."
And that approach, Siegman says, makes even the most difficult times rewarding. "You know you are doing your very best to make the lives of your patients a little bit better," she says. "There is a love that you share. That's kind of a quirky word, love. But on this service, it rings true."
David Greenwald is editor of UCLA Medicine. Kim Irwin, director of media relations for UCLA's Jonsson Comprehensive Cancer Center, contributed to this article.