Cutting-edge cancer treatments from Jerusalem put patients at forefront
Jerusalem’s Shaare Zedek Medical Center prepares for a new era in cancer care
By ALAN ROSENBAUMDR. SHANI PALUCH-SHIMON and Prof. Nathan Cherny at the future site of the Shaare Zedek Cancer Center and Radiotherapy Institute. (photo credit: EZRA LANDAU)
‘Patients receive comprehensive care from the first stage of diagnosis with our leading breast radiology department, followed by surgery, medical oncology, cancer genetics, fertility preservation, psycho-social support, palliative care and survivorship care.” The speaker is Dr. Shani Paluch-Shimon, director of the Shaare Zedek Medical Center Oncology Department in Jerusalem.Paluch-Shimon is an active, on-the-move and energetic mother of three young children. At age 43, she is the youngest oncology department director in Israel, and is dedicated to putting patients’ needs at the center of oncology treatment at the hospital. She is also deputy editor for the international breast cancer guidelines for the European Society of Medical Oncology. She has written the international guidelines on cancer in young women, and those on prevention and screening with a hereditary cancer syndrome, and is a member of the international consensus panel for metastatic breast cancer.“Our approach,” she explains, “is a holistic one that is based on patients’ needs and takes into account all aspects of the patient’s care.” Treatment for cancer patients at Shaare Zedek encompasses both physical treatment of cancer and assistance in dealing with the psychological aspects of the disease.One of the major new developments at Shaare Zedek in cancer treatment is the advanced Radiotherapy Institute, which is currently under construction. Radiotherapy uses high-energy rays, such as X-rays, to destroy cancer cells in the areas where they are targeted. Some cancers can be cured by radiation therapy alone or combined with other treatments. Depending on the circumstances, the therapy is also used to control cancers, relieve symptoms of the disease, or to make other cancer treatments more effective.“The Radiotherapy Institute will provide the latest cutting-edge technology in radiation therapy,” says Paluch-Shimon, “and will be led by Prof. Ben Korn, an internationally renowned radiation oncologist and leader in the field in Israel. The addition of the radiotherapy center will transform the Oncology Division into a comprehensive cancer center.”The new cancer center is the first stage of a master plan and is being built adjacent to what will be a large parking area with 800 spaces. The second stage will involve building of a cancer hospital.Another aspect in which Shaare Zedek is rapidly advancing is in the area of clinical trials of new drugs. Paluch-Shimon says the number of clinical trials for evaluating new drugs under development has tripled at the center in the last year alone. The vast expansion in clinical trials at Shaare Zedek provides oncology patients with the opportunity to receive the newest drugs in development, and benefit from the most promising new therapeutic options.“THESE CLINICAL trials give our patients the opportunity at all the different stages of their disease to access the latest drugs that are under development that might include biological therapies or immunotherapy. These clinical trials give our patients important therapeutic opportunities – and hope.”Another way in which oncology patients are placed in the center of care is through the hospital’s multi-disciplinary approach to patient care. “Optimizing cancer care is about multi-disciplinary care,” says Paluch-Shimon. “That includes regular staff meetings to discuss new patients and challenging cases within the department. But it also means a dialogue with our colleagues in the other departments to ensure that all aspects of the patient care have been taken into consideration when making tailored, appropriate decisions for their care.”As an example, she cites the field of breast oncology, where weekly meetings are held with the surgeon, radiologist, pathologist and nurses, as well as with the social care staff, to address the specific needs and nature of the individual patient’s treatment.
Paluch-Shimon adds that one of the department’s goals is to set up multi-disciplinary clinics where patients can see all the medical personnel needed on one specific day. “It will make their care more streamlined and effective,” she says.Shaare Zedek is equally devoted to addressing oncology patients’ psychological needs. “We have clinical social workers, and we were the first department in the country to have spiritual care workers,” says Paluch-Shimon. The spiritual care program, which was initiated by Prof. Nathan Cherny, the director of the Oncological Pain and Palliative Care Unit, provides personal spiritual space for patients, their families and friends and for the medical staff working with them, and works with all groups of the Israeli population – Jews and Arabs, Muslims and Christians, among others – and accompanies them on their journey to finding the best spiritual tools appropriate for their individual situations. Cherny is an international authority on palliative care and leads an international working group that has developed tools to help regulatory and health care authorities and professionals evaluate new cancer therapies.“In addition, we now have a rapidly expanding psycho-oncology team,” says Paluch-Shimon, who in addition to serving as director of the Oncology Division, heads the hospital’s Breast Oncology Program and the Talya Center for Young Women with Breast Cancer, the only center for young women with breast cancer in Israel. The department also has a survivorship program led by Dr. Na’ama Constantini, a sports medicine expert, and Dr. Ora Rosengarten, a medical oncologist.“THE PROGRAM helps the women get back on their feet with an exercise program and a program that addresses all their day to day needs, getting them back into a routine and getting them to a place where they feel good about themselves once they’ve completed their breast cancer care.” She adds that Shaare Zedek plans to expand this program for other types of cancer.Paluch-Shimon says the idea of having a patient navigator/case manager is another new development that has come from the Talya Center. “The concept of a patient navigator,” she explains, “is someone – not a doctor or a social worker – who helps navigate and coordinate the patient’s care, particularly at the time of diagnosis, when they are completely overwhelmed and are learning a new language. They help organize and coordinate everything the patients need, and they also guide the physicians when we need to bring in other types of health care professionals to help the patient. They also help the patient prepare before they meet with the oncologist to help them prepare all the questions that are important to them. It really changes the patient experience. It’s very significant.”Oncologists at Shaare Zedek are engaged in significant cancer research in various areas. One area examines the disparities of health and healthcare across different groups in society. “We are using the unique demographic of Jerusalem,” says Paluch-Shimon, “in order to help us look further into identifying health disparities between different communities and identify where the problems are and enhance our level of care.”Another important area of research is in the field of mutations in the BRCA1 and BRCA2 genes, the two breast cancer susceptibility genes. Women who inherit mutations in these genes are at an increased risk of developing breast and ovarian cancer. This mutation is especially common in Israel, with approximately one in every 40 women of Ashkenazi origin (2.5%) being a carrier. Beginning next year, the hospital’s Noga Clinic – a multi-disciplinary clinic for women who were diagnosed with a mutation in the BRCA genes – will be participating in an international study testing an experimental drug that may lower their risk of developing breast cancer. In addition, the hospital is participating in another international study that is examining pregnancy after breast cancer.“Shaare Zedek is the only center in Israel that’s active in that study. It hasn’t been done before and it’s an international effort.”Shaare Zedek’s oncology department, with Dr. Shani Paluch-Shimon at its head, a cutting-edge Radiotherapy Department in the works, the focus on cancer research and clinical trials and above all, with its patient-centered model of care, will continue to provide excellent care to its patients for years to come.This article was written in cooperation with Shaare Zedek Medical Center.
