Overview

The Cancer Partnership is the result of a first-ever collaboration between four leading medical groups – Providence Everett Medical Center, The Everett Clinic, Western Washington Medical Group and Northwest Washington Radiation Oncology Associates. The Cancer Partnership hosts some of the most sought-after cancer technology never before available in the Puget Sound region. It offers all aspects of outpatient cancer care under one roof. In this interview, Dr. Neuger addresses breast cancer treatment, The Everett Clinic, and communicating with patients.

Interview with Dr. Elizabeth L. Neuger, MD, The Everett Clinic

INTERVIEWER: How do you help set expectations? Patients obviously have a lot of anxiety: you’re talking about cancer, we’re talking about life threatening things, we’re talking about surgery. How do you bring them into this process so that they can have their anxiety reduced and so they know what to expect?

DR. NEUGER: That’s one of the reasons we really need to do face-on-face meetings. You need to look at the patient and see how much they can handle at any given time, especially when you’re dealing with cancer patients. You have to measure them and see: are they ready to hear that chemotherapy is in their future? Are they ready to hear that really a mastectomy is what needs to be done? It’s a process, it’s not cut and dry, you don’t come in: this is your diagnosis, this is your treatment.

With breast cancer specifically there are so many fantastic treatments, many of them have equal outcomes, and patients have a lot of choices. It can almost be overwhelming when they show up in my office. You know, they’ve been told that they have breast cancer, and they have all these options.You have to sit down and really get the feedback, their facial expressions, are they really understanding what I’m asking, and most importantly, we try to make sure they have a support person with them to help guide them through. With breast cancer, we actually have a nurse practitioner, or two nurse practitioners, to help guide them through the procedure: who to go see when, they help them make the appointments.

Our computer system helps out immensely with phone calls. Every phone call is logged. We know that you called, we know that you need an answer at the end of the day. We go through and make sure that everyone who’s called gets an answer to their question or gets told, given a timeline of when they’ll get the answer. So the computer system helps with all that.

There’s no way to get rid of all the anxiety. We do our very best to try and make sure we talk at the patient’s level, and we try not to talk above the patient, using fancy words, using initials that the patients may or may not understand. Because patients who understand what ‘s going to happen, they may not like it, but it’s easier to tolerate if you know what’s going on.

INTERVIEWER: You said something really interesting in there, which is that there are a lot of options. So I would imagine there’s this incredible balance: you’re the expert to make the recommendation, but there are also a lot of options, because you have a choice. So, how does that work? How would you characterize their decision making within this process?

DR. NEUGER: A lot of times I give the patients all the information, which can be overwhelming. So I will say, for example to a breast cancer patient, you have the choice of a lumpectomy with radiation treatment or mastectomy. And the longevity of life, how long you live with either one of those is exactly the same. But, then you need to look at which one would benefit you the best. So, I tell people, for example, if you’re high-anxiety, a mastectomy may benefit you more because you don’t have to undergo mammograms in the future. But, you’ve had your breasts for a long time, and you may very well be attached to your breast, and it may not be necessary for you to lose it. So, if you’re very attached to your breasts, I encourage you to go with a lumpectomy.

Now, certainly, everything varies with the diagnosis. Some patients aren’t candidates for both of those. But, if you are a candidate for both, I lay out the options, and if the patients want, I give them my recommendation of what I would do. But I try to encourage the patient to make an informed decision for themselves.

Founded in 1924, The Everett Clinic has a history of excellence that has earned both local and national recognition. The Everett Clinic has been named on the FORTUNE magazine’s “100 Best Company To Work For” list, as well as receiving the National Acclaim Award (the highest award honoring organizations that bring safer healthcare to patients), and the American Medical Group Association Advocacy Award, which brings attention to organizations who offer high-quality, cost-effective treatment to clients.  This has lead to presentations in front of Congress, selection into prestigious national health projects, national media coverage and much more.

From The Everett Clinic’s beginnings with only three physicians, to their present day with over 400 providers and 40 specialties, their emphasis has always been to provide cutting edge medical services that constantly adapt to meet the needs of the Snohomish community.

Overview

The Cancer Partnership is the result of a first-ever collaboration between four leading medical groups – Providence Everett Medical Center, The Everett Clinic, Western Washington Medical Group and Northwest Washington Radiation Oncology Associates. The Cancer Partnership hosts some of the most sought-after cancer technology never before available in the Puget Sound region. It offers all aspects of outpatient cancer care under one roof. In this interview, Dr. Neuger addresses breast cancer treatment, The Everett Clinic, and communication between departments.

Interview with Dr. Elizabeth L. Neuger, MD, The Everett Clinic

INTERVIEWER: How do you coordinate care after the surgery with primary care physicians, and how are you intertwined with that?

DR. NEUGER: Everett Clinic patients are so easy to care for because of the computer program. When I see a patient post-operatively and I clear them from a surgical point of view, my note gets sent immediately to the primary care doctors, and they have it at their fingertips. The oncologists have it at their fingertips, especially for breast cancer.

Our breast cancer program in The Everett Clinic is as good as any breast cancer program around. You know, having been at the University of Washington and here… There’s nothing better than what we have here.

Communication is absolutely one of the most important things in patient care. Whether it between the radiologist, the oncologist, the primary care doc. And, even though the breast center itself isn’t part of The Everett Clinic, we actually meet weekly with the radiologist, with the pathologist, with the radiation oncologist, the cancer doctors, the physical therapist, the people running the clinical trials… We all meet as a group weekly to discuss these patients. Breast patients are discussed that way. Primary care patients, we discuss with them. Patients who don’t have cancer… It’s just easy communication.

INTERVIEWER: Is that a unique model to care here? I’ve never heard of such a diverse group of experts coming together and discussing individual cases, one at a time.

DR. NEUGER: I think for breast cancer you’ll find that in various places, in various degrees. I can say that the breast cancer conference we hold here is very well-attended by all specialties. I can’t think of a time where we didn’t have all breast cancer specialties covered at the conference.

I can’t speak as to whether or not that’s true everywhere. I know that every patient who comes through our breast center, who has the diagnosis of breast cancer, gets filtered into that conference. You know a lot of places, the doctors have to call and request that the patients be put into the conference. Every patient who gets diagnosed at the breast center here shows up on the conference list.

The patients don’t go to this conference. This is where the doctors sit around and we look at every x-ray, we look at the pathology slides. You know, most surgeons just look at the pathology report. We actually look at the pathology slides, where we say “This is the cell, this is the margin, is this an adequate margin?” I sit next to my friend, who’s a radiation oncologist, who also is a specialist in their field? And they say, “Yes, that’s an adequate margin,” or, “No, you need to go back and do more.”

You know, just last month a paper came out about how to treat auxiliary node disease in breast cancer which is changing. It used to be that if you had a positive sentinel node, you would take all the lymph nodes out. Well, this paper came out last month, and we were already talking about it at our conference this morning… We had a patient who fit the criteria, who had a positive sentinel node, who now will be spared another surgical procedure because of this new paper that came out just a month ago.

Founded in 1924, The Everett Clinic has a history of excellence that has earned both local and national recognition. The Everett Clinic has been named on the FORTUNE magazine’s “100 Best Company To Work For” list, as well as receiving the National Acclaim Award (the highest award honoring organizations that bring safer healthcare to patients), and the American Medical Group Association Advocacy Award, which brings attention to organizations who offer high-quality, cost-effective treatment to clients.  This has lead to presentations in front of Congress, selection into prestigious national health projects, national media coverage and much more.

From The Everett Clinic’s beginnings with only three physicians, to their present day with over 400 providers and 40 specialties, their emphasis has always been to provide cutting edge medical services that constantly adapt to meet the needs of the Snohomish community.

Biography

Perry A. Soriano, MD, joined The Everett Clinic in 2008. He received his medical degree from the University of Chicago in 1999 and completed his residency at Caritas St. Elizabeth’s Medical Center of Boston in 2004. Dr. Soriano is board certified in Surgery and completed fellowships in surgical oncology at the National Cancer Institute, National Institutes of Health in Bethesda, Maryland and at City of Hope in Duarte, California. In this interview, Dr. Soriano addresses surgery, The Everett Clinic, and communicating with patients.

Interview with Dr. Perry Soriano MD, The Everett Clinic

INTERVIEWER: Looking at the body of work that you’ve accomplished and the training you have, what would you say that you’re the most proud of?

DR. SORIANO: In working with cancer patients, the most challenging aspect of the job is to be able to communicate the overall picture of what they have, coming into the office. So, to go through their pathology report, go through their diagnoses and talk about what steps are necessary, what steps are recommended; and, then on top of that, to go through what steps are most appropriate for that individual, is one of the largest challenges.

We have very clear guidelines for the majority of cases, though not all, but we have very clear guidelines for management for many of our cancers that we see. So, the challenge is to individualize that treatment for the particular person, and to communicate it in a way that makes sense. Certainly when people come in and have a diagnosis of cancer, their mind typically is racing. Usually people come in with their family, always a good idea, because you’re only going to be able to absorb so much.

I think the thing that I am very proud of in going through the training, you know, medical school, surgery residency, fellowship training, etcetera, and then being out in practice, is being able to sit down and actually explain this scenario to people and their families, so that they have a sense of what is coming.

And luckily, I don’t do that on my own. My colleagues have similar discussions. The gastroenterology specialists, the medical oncologists, the radiation oncologists… but it’s a challenge to convey that to people, and to give them their options, and to allow them to see the scenario, and participate in the decision making. And I think that’s what I’m most proud of in my practice.

The complex surgical procedures are long cases, they require stamina, so I’m proud of that as well. Being able to do complex pancreatic surgery takes additional training, and time, special interest in these cases. On the other hand, I think the thing that is even more important is being able to bring people through a big operation, so that they understand the course of surgery, recovery, so that they can prepare.

Founded in 1924, The Everett Clinic has a history of excellence that has earned both local and national recognition. The Everett Clinic has been named on the FORTUNE magazine’s “100 Best Company To Work For” list, as well as receiving the National Acclaim Award (the highest award honoring organizations that bring safer healthcare to patients), and the American Medical Group Association Advocacy Award, which brings attention to organizations who offer high-quality, cost-effective treatment to clients.  This has lead to presentations in front of Congress, selection into prestigious national health projects, national media coverage and much more.

From The Everett Clinic’s beginnings with only three physicians, to their present day with over 400 providers and 40 specialties, their emphasis has always been to provide cutting edge medical services that constantly adapt to meet the needs of the Snohomish community.

By Renee Pullman

Ovarian cysts hurt, they can ruin your life. Because of this, going to the doctor doesn’t put you in the most objective frame of mind — you just want an answer. The trouble is many treatments just cover up the symptoms. This only leaves you a little better off. Ovarian cysts are something every woman faces at some point in her life so women need to understand what works and what the options are.

If you go to the doctor with the symptoms he will run tests and perhaps look at your ovaries with ultrasound to find out if you have cysts or not. If you have them it is time to choose whether to surgically remove them or do nothing and wait to see what happens. Often cysts will go away on their own, the bodies natural mechanisms will remove them with no medical interference.

On the other hand your doctor may describe birth control pills, in other words a hormone dose to try to clear up the cysts. The other method is surgery. These methods do not get to the underlying causes, they only mask them. Many times after these approaches are tried, the cysts come back. This is why many women look to natural treatments to clear their ovarian cysts.

Natural treatments and methods are real and have long been used to treat ovarian cysts and keep them from returning. These methods work best because you are different from other women, and the natural methods gives your body what it needs to handle your cysts. These natural methods are done at home and instead of masking the underlying causes of the cysts they actually eliminate the causes and truly end the problem.

As a woman one of the best things to do is learn something about the natural treatment of ovarian cysts. What we are looking at here could be a simple change in diet. If you don’t have the cysts now, then these diet changes may prevent you from ever having them. Other natural treatment methods are long warm baths and stress reduction techniques. Yoga can help as well. There are many useful techniques that can help you.

If you are a woman in her child bearing years and are concerned about ovarian cysts and fertility, if you are trying to get pregnant, set your mind at ease. Begin to improve your diet, begin to reduce stress in your life, and do the things that prevent ovarian cysts. These same things will improve your overall health and help create a happier life all around.

Make the positive choices for a health lifestyle and enhanced happiness. I invite you to visit our website to learn more about natural treatment of ovarian cysts.

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