National Comprehensive Cancer Network

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Duke Comprehensive Cancer Center
Durham, North Carolina
888.275.3853 (888.ASK.DUKE)
www.cancer.duke.edu

Adult Oncology Services

Introduction

Since its inception in 1972 as one of the nation's first comprehensive cancer centers, the Duke Comprehensive Cancer Center has been at the forefront of efforts to understand, prevent, diagnose, and treat cancer through patient care, clinical research, laboratory investigation, and education. Every activity the Cancer Center undertakes-from basic research to clinical trials to educational programs-is aimed at improving the care of cancer patients.

The Duke Comprehensive Cancer Center is a matrix center-one that draws upon the depth of basic scientific research and clinical expertise of the Duke University Medical Center. The formal structure of the Cancer Center consists of:

· 11 established research programs (divided into basic, translational, and clinical research programs)

· 16 Shared Resources

· 21 member Executive Committee

· Protocol Review and Monitoring System

The "comprehensive" status recognizes the center for its excellence in research and for other contributions in the areas of clinical trials, prevention and control efforts, information and educational offerings, and outreach and service activities. The Center's more than 350 physicians and scientists research all aspects of cancer biology and treatment.

General Information

Treatment

Multidisciplinary Clinics

Stem Cell Transplant Program

Duke has earned national and global recognition for its leadership in bone marrow/stem cell transplantation. The adult program is renowned for its pioneering efforts in the treatment of breast cancer with autologous bone marrow/stem cell transplantation and innovative approaches to the treatment of leukemia, lymphoma, and myeloma. Duke is also recognized for its extensive research into a variety of treatment modalities that can be combined with transplantation. These include immunotherapy, anti-angiogenesis therapy, and the latest chemotherapy and pharmacologic therapies.

Alternative/Complementary Medicine

Founded in 2000, Duke Integrative Medicine draws from the very best conventional and complementary/alternative medicine strategies to create a plan to help you optimize your health. We offer you the opportunity to immerse yourself deeply into this experience, and then we partner with you to implement the plan over time.

We believe that collectively, you and your health care providers should develop a health plan to address the whole person, because we believe there is a powerful interrelationship between the mind, body, spirit and community in both health and disease. All services are custom-designed to suit your individual needs and goals.

Integrative Oncology, a partnership between the Duke Comprehensive Cancer Center and DCIM, provides a conduit to bring Integrative Medicine services to patients at Duke and is developing a robust research engine to practically evaluate various Integrative Medicine interventions offered to our patients-establishing benefit, minimizing harm, and generating evidence-based advice.

Long-Term Cancers Survivors Program

Long-term survivors of childhood and young adult cancer represent a special, growing population of individuals who have lived through, and conquered, a unique set of medical and psychosocial challenges. With greater than 70 percent of all children and young adults being cured of their primary tumors, Duke now has the opportunity and responsibility to study the long-term effects of treatment on these patients. While a great deal of effort continues to be expended to reduce the potential short-term and long-term toxicity of multi-modality cancer therapy without sacrificing efficacy, there is ample evidence to suggest that many current approaches will also continue to produce late effects. Moreover, since cancer treatment is a constantly evolving process, patients who received older and perhaps outdated therapies must continue to be evaluated. Finally, since the ability to cure most children and young adults with a wide variety of tumors is still in its infancy, it is not known, nor fully appreciated, what effects multi-agent chemotherapy and/or radiotherapy will have in an aging population of patients. For these many reasons, it is vitally important to establish combined multi-disciplinary clinical and research programs that have the capability to collect data retrospectively and prospectively on a large cohort of patients, analyze that data, and deliver medical care both reactively and perhaps preventively, based upon this information.

Cancer Prevention and Screening

Established in 1991, Duke's Cancer Prevention, Detection, and Control Research Program explores genetic and environmental factors that increase risk for cancer, and evaluates interventions to promote behaviors that can prevent cancer, lead to its early detection, and help patients cope with cancer treatment. Program goals are to develop, evaluate, and disseminate interventions to improve the early detection of cancer and promote behaviors that can prevent cancer and to identify genetic and environmental risk factors for cancer. Program activities include:

Support Services

The Duke Center for Survivorship encompasses the services of Duke's Cancer Patient Support Program, Duke's Oncology Recreation Therapy, and Duke's Cancer Education Program. Therapy, support, and education resources are offered to patients by professionally trained counselors and hundreds of volunteers.

The Center provides support groups and individual counseling as well as image enhancement services to cancer patients and their families. Music, games, crafts, and laughter are used to optimize functioning, coping, and quality of life during treatment. Through the center, popular hobbies such as genealogy research, painting, woodworking, tiling, flower arranging, and more are provided to survivors as both an emotional outlet and recreation. Multimedia information is provided to help survivors and their families understand their treatment options, make decisions, manage the effects of cancer and treatments, and find meaning in the experience. Books, audiotapes, videotapes, and online computer resources are available in the Patient and Family Resource Center.

Support Groups:

* Breast Cancer Support Group

* Gynecologic & Breast Cancer Support Group

* Gastrointestinal & Pancreatic Cancer Support Group

* KidsCan! Support Group

* Leukemia, Lymphoma, and Multiple Myeloma Support Group

* Look Good...Feel BetterŪ Program

* Lung Cancer Support Group

* Prostate Cancer Support Group

Nutrition Service

The Duke Health and Fitness Center, part of the Duke Center for Living, offers a program specifically to support cancer patients upon diagnosis, during, and after treatment. The C.A.R.E. program-Cancer and Regular Exercise-includes access to the Health and Fitness Center facilities and classes, an exercise program tailored to your goals and limitations, mind-body classes, and wellness lectures. Individualized nutritional counseling is also available. Call 919.660.6660 for more information or online at www.dukefitness.org.

Supportive Care

Pain Service and Palliative/Supportive Service

The Center for Palliative Care at Duke University Medical Center addresses the management of pain among patients from several perspectives.

Inpatient Pain Management

Duke University makes the control of our patients' pain a priority. Upon admission to Duke, most patient's pain is managed by the primary medical team. In the event a patient requires surgery, pain is initially managed by the patient's anesthesiologist and then by the patient's surgical team. Our anesthesiologists practice a multi-modal analgesia approach to pain which often begins with pre-emptive analgesia, that is, medications given prior to surgery in an attempt to prevent pain before it even starts. After surgery, many methods of pain control are available; these include IV medication (opioids) by patient controlled analgesia (PCA), regional anesthesia (nerve blocks or catheters) that provide local anesthetic to a specific limb or epidurals which deposit local anesthetic and opioids in the epidural space. As the patient begins to take sustenance by mouth, IV medications are typically transitioned to oral analgesia.

The Acute Pain Service (APS)

The Duke Acute Pain Service (APS), under the direction of Dr. Brian Ginsberg and with the assistance of four rotating attending anesthesiologists, provide 24/7 patient care coverage. Five full-time registered nurses (clinical nurse specialists), Duke Pain Medicine Fellows, senior anesthesia residents and medical students also participate in patient care.

The APS coordinates and manages pain in patients who elect to have analgesia administered via epidural or regional

anesthesia routes as well as in patients who present with complicated pain syndromes. The APS may be consulted by the primary medical providers when patients, adult or pediatric, are experiencing pain that is difficult for the primary team to manage. The APS utilizes a multimodal approach to pain management. The APS often works in conjunction with Physical Therapy and Stress Management experts to provide comprehensive care of our patients experiencing pain. The APS attendings are also intimately involved in pain management education hospital-wide.

Outpatient Pain Management

Outpatient Pain Management is based at the Duke Health Center Morreene Road Pain Clinic. This clinic is staffed with an interdisciplinary team that includes practitioners from Anesthesiology, Neurology, Neurosurgery, Psychology, Psychiatry, Nursing, and Physical Therapy. Patients undergo an extensive initial evaluation which results in an individualized, interdisciplinary treatment plan. A variety of pain management techniques are offered, including but not limited to complex medication regimens, single and multiple level nerve blocks; the evaluation, insertion, and management of epidural pumps and/or spinal cord stimulators; physical therapy techniques; and strategies including relaxation, biofeedback, and stress management. The Duke Morreene Road Pain Clinic evaluates and treats older adolescents and adults while pediatric patients are evaluated in a Pediatric Pain Clinic located in the Duke Children's Hospital.

Non-Pharmacological Management of Pain

Non-pharmacological management of pain is provided through several groups at Duke University Medical Center. The Stress Management Consult Team consists of one full-time and four part-time advanced practice registered nurses who work primarily with patients and their families during hospitalization. This team works with and educates

patients to manage their pain through relaxation techniques and complementary modalities. They also work with and educate various health care providers to help them provide better care and support to the patients. The Medical Psychology staff consists of psychologists who are available on a consultation basis and provide various non-pharmacological interventions such as biofeedback and relaxation exercises to both inpatients and clinic patients.

Home Care/Hospice Services

Duke HomeCare & Hospice is a community focused home care agency drawing on over 25 years of experience in providing quality home care to those in need. Duke HomeCare & Hospice provides innovative, thoughtful care, using an interdisciplinary team approach, to achieve the best possible outcomes for the patients, families, and communities. Their staff is on-call 24 hours a day, seven days a week to serve your needs.

Duke Home Infusion provides compassionate, quality home infusion care using a multidisciplinary approach and the most effective and efficient utilization of resources to achieve the best patient outcomes. Duke Home Infusion is JCAHO accredited.

Duke Home Health provides certified home health services for adult and pediatric patients needing nursing, rehabilitation (physical, occupational and/or speech language pathology therapies) and home health aides. When medically necessary, the services help patients adapt and recover from illness or injury in the comfort of their home.

Duke Hospice cares for patients who are seeking palliative end of life care. They provide care designed to manage symptoms and provide emotional and spiritual support. Care can be provided in the home, at an assisted living facility or in nursing homes. They also provide care in their six bed Inpatient Care Facility in Hillsborough, NC.

Duke Community Bereavement Services provides bereavement care to primary caregivers/family members of Hospice patients for up to 13 months following the death of a loved one. They also offer bereavement services to anyone in our community who has suffered a loss due to death or who requires critical incident debriefing..

Cooperative Group Membership

Clinical and Research Efforts

Duke is a member of the National Comprehensive Cancer Network (NCCN) and is the headquarters for the biostatistics group and data management group for The Cancer and Leukemia Group B (CALGB) and the overall headquarters for the American College of Surgeons Oncology Group (ACOSOG). At any one time, approximately 360 active protocols for new cancer treatments are open for patient enrollment at Duke. Over 1,000 patients are enrolled in cancer treatment research protocols, and another 1,500 to 3,000 individuals in companion and cancer control studies each year. Well-established teams of specialists in radiology, pathology, surgical, radiation, and medical oncology provide multidisciplinary care for individuals with breast cancer; lung cancer; and hematologic, gastrointestinal, and other malignancies.

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